ACQUIRED BY
CORPORATION OF Gi.AS'GOW.
REPORT
ON CERTAIN
CASES OF /PLAGUE
/
OCCURRING IN GLASGOW,
/
IN 1900,
BY THE MEDICAL OFFICER OF HEALTH.
PRINTED BY ROBERT ANDERSON, 142 WEST NILE STREET, GLASGOW.
Digitized by tlie Internet Archive
in 2015
https://archive.org/details/b21359167
PREFACE.
The issue of this Eeport has been delayed for the purpose of affording time for
the completion of some enquiry which was instituted with the view of acquiring a
more intimate Imowledge of the pathology of plague, and of the changes which
take place in the blood serum of the patient. With this object the Report includes
a description of the Symptomatology and Sero-therapeutics by Dr. Brownlee,
Physician-Superintendent, Belvidere Hospital; Dr. Campbell M'Clure, lately
Senior Resident Assistant Physician, contributes a section dealing with the
Clinical Bacteriology ; Dr. D. Louis Cairns, who has succeeded him, undertook
an investigation into the agglutinating properties of the blood serum, and
Dr. R. M. Buchanan, Bacteriologist to the Corporation, has reviewed the morbid
anatomy and bacteriology.
It is hoped that in this way a more complete picture of the outbreak will be
presented, and something of permanent value added to the technique of the
resources available for the recognition of the disease.
A. K. CHALMERS, M.D.,
Medical Officer of Health.
Sanitary Chambers,
Glasgow, August, 1901.
CONTENTS.
Page
Introduction, - - - - - . . . 5
Former Plague Prevalences in Britain, - - . . 6
Association and Topographical Distribution of Cases, - - 8
Types of the Disease present, - - - - - 16
The Conditions of Spread, - - - - - - 17
Administrative Measures, ------ 21
Venice Convention, ------- 27
Protective Inoculation, 30
Meteorology, - - - - - - - - 31
Plague in Glasgow in the 17th Century, - - - - 37
Notes regarding Symptomatology, - - - - - 39
Clinical Histories of Cases, ----- 43
Clinical Bacteriology, ------ 57
Sero-therapeutics, ------- 59
The Agglutinating Property of the Blood Serum, - - 62
Morbid Anatomy and Bacteriology, - - - - 73
Microscopical Examination of Fresh Tissues, - - - 77
Do. DO. in Section, - 78
Culture Experiments, - - - - - - - 81
Inoculation Experiments, - - - - - - 82
Mode of Infection, - . - - _ . 83
Bacteriological Diagnosis, - - - - - - 84
Precautions observed in connection with Post-mortem Examina-
tions AND Inoculation Experiments, - - - 85
Examination of Rats, - - - - - - 86
Illustrations —
Map of Special Cleansing Area, facing - - - 10
Photographs of Buboes, &c. Plate A, facing - - 42
Charts showing Temperature, Pulse, and Respiration
Rates, faoing - - - - - - 56
Illustrations of Morbid Anatomy and Bacteriology.
Plates I.-V., following ----- 86
INTRODUCTION.
The reappearance of a disease which had long ceased to have any save an
historical interest to the population of Glasgow is of more than passing importance.
When Plague appeared in our midst, in the autumn of 1900, it" abruptly re-
opened a record in which the last entry was contemporaneous with the period of
the Restoration, and of which the pages of Defoe and Boghurst may be said to have
been regarded by generations as the closing chapters.^
To some extent the awakening was a rude one. In an interval of two
centuries and a half there is room for much to happen in the history of a
population; but its reappearance has shown that we have acquired no
racial immunity to plague, and that some of the physical conditions necessary
for its development are still present with us. Nor has the disease changed. Its
type may be modified by circumstances, but it is still capable with us of manifesting
a considerable degree of malignity. In our recent experience, in one household of
two persons both died, as did a neighbour ; in another of six persons, all were
attacked, and only two recovered.
Of the cases recognisable as plague during their currency 28'5 per cent,
proved fatal, but there were eight other deaths inferentially attributable to the
disease, because of their association with subsequent and definitely recognisable
cases, which bring up the number of deaths to sixteen, and the attacks to thirty-
six.
There is much to be learned regarding the methods by which plague spreads.
There are many who question whether it is infectious, or communicable
from man to man, in the sense in which measles is communicable ; whether,
in fact, risk of contracting the disease arises from association with the plague-
stricken patient or with an infected place. So far as the disease is an affection of
mankind, it would seem as if infectivity depended on the tyj)e which it assumes in
the individual patient. In the limited experience which our cases afforded,
secondary cases in inmates of the same house, or in visitors, followed only when the
original attack was pneumonic or diarrhoeal, or septicsemic in type. There was no
evidence that the simple bubonic form, even when severe and treated for a
lengthened period at home, transmitted the disease."
The explanation would appear to be that in these latter forms the bacillus
pestis is usually confined to the affected glands, and has no means of escape there-
from until in time it becomes degenerate and loses its virulence, or secondary
suppurative changes occur, which are generally hostile to it.^ In the pneumonic
type, on the other hand, the atmosphere surrounding the patient may contain
suspended particles of expectoration, and a true infectivity of the immediate neigh-
bourhood of the patient become established.
1 Much interesting information regarding the action of the Town Council in plague years,
especially during the 17th centurj', is contained in the Charters and Documents relating to the City
of Glasgow, 1175-1649, Part I., published by Sir James Marwick, and I have to express my indebted-
ness to Dr. William H. Hill, of Ingram Street, for an opportunity of perusing many valuable MS. notes
on the condition of the city and of the customs of the citizens during that period. A very concise
description of the ravages of plague in Glasgow at that time, and of the action of the Town
Council, appears in the Memorials of the Faculty of Physicians and Surgeons of Glasgow, by
Alexander Duncan, Esq., LL.D., secretary of the Faculty, ard extracts therefrom will be found on
p. 37.
2 There were two apparent exceptions to this — the secondary case at Oxford Lane and the tertiary
attacks in Dale Street. In the former, association with the wakes cannot be excluded ; in the latter
there was present in the house in which they contracted their infection the bed on which a pneumonic
patient had died.
3 In one case, however, the bacillus pestis was recovered in a virulent form from a bubo rupturing
spontaneously ; in another it co-existed with putrefactive bacilli found post-niortem in a bubo,
although it was absent from the discharge therefrom during life.
6
But there is another form of plague prevalence of whicli we had no experi-
ence. The disease affects both man and some animals, and in this resembles
anthrax, glanders, and tuberculosis. In our recent experience it was confined to
man.
The susceptibility of rats to plague, and the part played by these animals,
when infected, in spreading the disease, is now well recognised. In the Formosa
outbreak of 1896, plague was known as rat sickness, and the dissemination
of the disease as an affection of mankind in Sydney, in 1900, was preceded by
a rat infection. The distribution of infection over wide areas is thus easily
accomplished, although the operation of still another factor seems to be required
to transmit the disease to man. It is a laboratory fact of no mean significance
that cultures of the plague bacillus are notoriously prone to lose their virulence.
In the body of a rat dead of plague the bacillus must find an equal difiiculty
in maintaining it. But the sick rat becomes an attractive host for fleas, which
rapidly leave it when death occurs. These insects, together with flies, lice and ants,
are capable of conveying the infection, and indirect contact may thus be established.
There is much evidence to show that plague infection more commonly gains
access to the system through some injury — it may be a trifling one — to the skin
or mucous membrane ; there is little in favour of it ever being acquired through
food. If the bite of an insect, acting as the temporary host of the bacillus of plague,
inoculates the disease through the puncture, after the manner in which the
malarial parasite is transmitted through the bite of certain mosquitoes, the locality
of infection and contact therewith both acquire an elastic meaning. It has been
shown that from the rat-infected flea the bacillus may be recovered; although
experiments are awanting to show how long it may remain virulent in the insect.^
In the cases which came under observation there was a definite grouping of
those directly associated with the neighbourhood of " wakes," and there were
•certain others which had no such association. Taken by themselves, these latter
were but broken links in a chain, having in common only the fact that they were
plague-stricken. But in two instances antecedent deaths had occurred, one, at
least, of these being a visitor to a tenement in which it is now reasonably certain
that the septicsemic form of the disease had caused one death, and in which one
if not two others were, at the time, sick of attacks that were to prove fatal sub-
sequently. In two more, contact with the wakes, in the intermediate sense
already alluded to, could be established ; and in the remaining case, the wife of
an employe of the department had the infection conveyed to her in her
husband's clothing, though their home was far removed from the area of infection.
By placing the unrecognised deaths at home in the series of attacks, the
continuity of the series becomes established, and the agency by which the disease
was transmitted to the clothes collector's wife suggests the medium by which
" contact " for the apparently disconnected cases may have been established.
Plague Pandemic from 13th to 17th Centuries — Its Former Prevalence
IN Britain.
It may be of some general interest here rapidly to outline the scope of the
former prevalences of plague in this country.
To many the Great Plague of London stands as an incident by itself, quite un-
associated historically with any other event save the Great Fire which followed it ;
and when plague ceased after the fire had occurred, the theory that there was
no more plague because the fire had destroyed the places where plague had found
a home was too obviously a deduction from the facts to be doubted — for a time, at
least.
^ The part plaj'ed by the flea in the propasration of the disease among rats is so important that I
have introduced, on p. 30, an extract from a report by Dr. Tidswell, which accompanies that of the
Chief Medical Officer (Dr. Ashburton Tliompson) on the recent outbreak at Sydney.
7
But in Marseilles, about sixty years afterwards, and in Moscow, in 1770, out-
breaks of the disease occurred with a virulence almost equal to that which made
the Great Plague historical, and with it they form the major incidents in the
recession of a pandemic which lasted for more than four centuries and had
included the whole of Europe in its ravages.
It is necessary to recall this in order to appreciate what underlies the phrase,
again so common in recent years, in describing the present diffusion of plague, for
there is a suggestiveness in the widely extended cyclical movements of this disease
which raises It above the category of those which are wholly dependent on local
causes. On two former occasions, at least, plague extended to Britain. The
Justinian outbreak, which devastated Europe in the sixth century, appeared in
Britain in that which followed, and the Black Death, of the fourteenth century,
were both examples of a Western diffusion of plague, which reached Europe in the
former instance through Egypt, and in the latter came overland from China. But
while the Justinian Plague appears to have exhausted its malignancy in Britain in
twenty years (664-685), the Black Death left its impression on our epidemic history
for three centuries, until, indeed, its final extinction some fourteen years after the
occurrence of the Great Plague in London in 1665.^
During the centuries which lay between the appearance of the Black Death
and the occurrence of the Great Plague, the disease was endemic in Britain — ■
tending latterly to linger among the population of towns, having a certain
periodicity in the times of its maximum prevalences, and almost capriciously
capable, as in the great outbreaks in London, Marseilles, and Moscow, of displaying
the malignity which three centuries earlier had earned for it the name of the
Black Death.
Following its extinction in this country, it was wholly absent from Western
Europe during the greater part of the eighteenth century, and its further recession
may be told in a quotation from Mr. Netten Radcliffe : — At the close of the first
third of the nineteenth century the area of the prevalence of the disease had
shrunk to the easternmost parts of the Turkish Empire in Europe, and in the year
1841 plague ceased on the Continent altogether."
Almost simultaneously it had been receding along the Southern shores of the
Mediterranean, and its disappearance from Syria, Asia Minor, and Egypt, in 1844,
encouraged the hope that a disease which had left its impress on the epidemiology
of five centuries had been extinguished in the struggle which mankind is ever
waging with the uncontrolled forces of nature.
It is from this point that the increasing prevalence of plague in recent years
must be measured, for although the Hong Kong outbreak of six years ago stands
almost at the beginning of a new era of wide distribution, the importance of this, as
a factor in its distribution, is limited to the facilities for transit which the commerce
of Hong Kong placed at its disposal. Indeed, the distribution of plague and its
diffusion may convey quite distinct conceptions, for at the present moment plague
is more widely distributed than ever, whilst we are still slowly accumulating
evidences of its diffusion. For this, modern methods of commerce and travel are
responsible. In transit by land, epidemics diffused themselves along a caravan
route. The furthest point reached was but a step beyond the previous resting
place, and lateral diffusion along the route was possible. The Black Death reached
Europe in less than half a century after its probable origin in China, but the way
1 When the Black Death appeared in Britain, Europe had barely awakened from the sleep of the
Middle Ages. It began in Dorsetshire about August, 1348, reached London in the end of that year,
and in January, 1349, Parliament was prorogued "owing to the increasing severity, day by day, at
Westminster and places adjoining." Spreading northward it entered Scotland in the autumn of 1349,
appearing first among " the Scots assembled in the Forest of Selkirk for an invasion, at the time when
the mortality was greatest in the Northern Counties of England, but was held in check there
during the winter months following. Its former prevalence in Glasgow came to an end about
the year 1648.1
1 See " History of Epidemics in Britair," by C. Creighton, M D. University Press, Cambridge, 1S91.
8
thither was marked by its ravages. Now, in less than six years, both hemispheres
have been invaded, although this alone is an illustration of the method of distribu-
tion rather than evidence of pandemic intensity. For this latter we must look to
the Eastern haunts of plague, and there the evidences are sufficiently disturbing.
For while there is now some reason to doubt the reality of its disappearance in the
middle of the nineteenth century, its movement in the latter half has been towards
an ever-widening area of prevalence, and the century closes while the avenues of
commerce are being watched for its appearance with a minuteness probably quite
unparalleled. For plague is an international question, and commerce vibrates with
every evidence of its progress.
ASSOCIATION AND TOPOGRAPHICAL DISTRIBUTION OF CASES.
Written after the events described have terminated, it has been possible
here to deal with the outbreak as a continuous narrative, and to discuss many of
the questions which the association of cases suggested, but it has been deemed
advisable also to append the Interim Reports presented to the Health Committee
during the successive fortnights in which plague was present, as these best
convey the impression created by the events while still in their development.
When plague was recognised to exist, it had already invaded several families,
and had been present for at least a fortnight, almost certainly for three weeks.
It was suspected to exist on 25th August. On the 27th, a man was found
who had sickened on the 12th, while his wife was already dead on the 9th, and a
grandchild, a baby of two months, living with them, on the 7th of that month.
The circumstances attending the recognition of the disease, as related in my
Report to the Health Committee on 10th September, 1900, are as follows: — •
A child and its grandmother (Mrs. B. ), livhig in the sa,me liouse at 71 Rose Street, South-Side,
Glasgow, sickened suddenly' on the evening of 3rd August — the child dying on the 7th and the
grandmother on the 9th — the cause of death of the child being certified as "zymotic enteritis,''
and of the grandmother "acute gastro-enteritis." In both cases a wake was held, and the grand-
mother was buried on the 11th. Although the husband of this latter patient sickened on the 12th,
he was only admitted to hospital on Monday, 27th August, certified "enteric fever," when he
was recognised to be suffering from plague.
Concurrently with the later developments in this household, the following illnesses were
appearing in the members of a family (M.), 57 Thistle Street, some of whom had either attended
Mrs. B. 's wake, or were present during the illnesses in her house.
On the evening of Sunday, 19th August, a child, Christina M., 10 years, sickened with acute
symptoms, which ended fatally at mid-day on the 21st. She was only medically visited, however,
within ten minutes of her death. The symptoms were those of pneumonia, and the cause of death
was certified as "acute pneumonia."
Before the child died the mother had already sickened (20th) ; a son (since dead) sickened on
the 22nd, and a half-brother, a young child of three years, sickened on Thursday, 23rd. ^ These
three were first seen by Dr. C. E. Robertson, who had also seen the child Christina, and later by
Dr. Colvin, who, on discovering that Dr. Robertson had already visited, went to confer with him
regarding the symptoms. The action in which this conversation ended is thus described by Dr.
Robertson : —
' ' We were satisfied that they were cases demanding the attention of the Sanitary Authorities,
and I agreed with Dr. Colvin that, having both seen them independently, we should both notify
them as cases of enteric fever, with a mark of interrogation after it, to imply that the diagnosis
was not definite, but that they were evidently of an infectious nature, and should be removed
at once. "
They were accordingly notified on 25th August, and removed to hospital same day.
On admission. Dr. Brownlee, the Physician-Superintendent, made a careful examination of the
cases, which resulted in his coming to the conclusion that the patients were suffering from bubonic
plague, although they were inhabitants of Glasgow, and there was no known case of bubonic
plague in Britain. Dr. Weir, Senior Assistant Physician at the Hospital, and Dr. Knight, my
' On sutsequent enquiry it was found that this patient sickened on 22nd.
9
assistant, concurred in the diagnosis. Dr. M'Cliire, Acting Sivperintendent of the Smallpox
Hospital, immediately examined blood-films obtained by hypodermic puncture of the buboes, with
the result that typical forms of the bacillus pestis were observed. Immediately on this conclusion
being arrived at, Dr. Knight visited the patient's house, verified the story of the illness and death,
and arranged for the removal of the other members of the family to the reception-house for
observation. Cultures taken on glycerine agar showed, by the evening of August 26th and the
morning of August 27th, the typical appearance, both macroscoj)ical and micioscopical, of the
bacillus pestis. Later in the week they wore fully confirmed by animal experiments by Dr. Muir,
Professor of Pathology in the University of Glasgow, in the absence of our own Bacteriologist,
Dr. R. M. Buchanan. (Professor Muir's Report will be found at p. 28.)
On the same day that these three cases were admitted (25th August), another woman (Mrs. T.,
23 Oxford Lane), had been admitted certified typhus fever. This disease was excluded on
examination, and owing to the presence of an inflammatory condition in the left groin, and a history
of recent confinement, the provision.al diagnosis of pelvic cellulitis was entertained. Later, her
association witli the B. family was discovered, and the diagnosis revised in the light of the symptoms
presented by these others.
The house occupied by the B. family was a single apartment on the ground
floor. It is distant at least a quarter of a mile from the river^ — considerably
further from the docks. The father, although a dock labourer, was employed
exclusively in vessels engaged in the coasting trade, and no evidence of other
association with shipping could be found. The mother was a fish hawker, and took
special charge of her grandchild. This is important, because the grandmother took
the child with her wherever she went, and they sickened simultaneously. It
suggests that they found their infection beyond the limits of their dwelling. On
the other hand, the child's grandfather, the dock worker, sickened on the day
following his wife's burial. The only other inmate of this house was a daughter —
mother of the baby referred to — and employed, until the date of her mother's
sickening, in a rag store. She was not affected.
In tracing the spread of the infection from this focus, a passing reference
is necessary to the social customs of the class to which these persons belonged
when death occurs, because here, as on a subsequent occasion of a similar
character in Thistle Street, they played an important part not only in the spread
of the disease, but in rendering its recognition easier.
Waking, or watching with the dead, is primarily an act of reverence and of
sympathy. But " wakes," as we now mostly know them, are an abuse of this
custom. They are lacking absolutely in reverence, and only a distorted conception
of friendship could construe them into expressions of sympathy. Hospitality is,
perhaps, natural in the circumstances, but its excess becomes debauchery, and when,
to this, indulgence in games is added, the last remnant of reasonableness in the
custom has gone. This digression is necessary for the purpose of explaining how
gross but temporary overcrowding occurred in the infected houses, and became a
powerful factor in the spreading of the disease. Considerably over one hundred
persons were present on one or other of the evenings on which these ceremonies
were held, and, as the families were related, many attended the " Avakes " in both
households. On the first occasion, the " wakes " were held during the evenings
from 7th to 10th August, and among those present were several members of a
family, M., residing at 57 Thistle Street. Four of these latter ultimately Avere
affected, but two only, I think, need be regarded as contracting their infection at
71 Rose Street. The first victim in this second family, a child (T. M.), sickened on
19th August, nine days after the last evening of the first " wake." Her mother
sickened on the following day, and two brothers on the 22nd. This child died on
the 21st, and here, again, on that evening, and on the 22nd, there occurred a
repetition of the ceremonies Avhich had taken place from the 7th to the 10th in
the Rose Street house. The first illness in the Thistle Street house was
pneumonic in tjqoe, and the two members of this household, sickening on the 22nd,
1 A reference to the accompanying map will help the reader unacquainted with the locality to
follow the distribution of the cases.
10
most probably obtained their infection from her. Subsequently to these " wakes,"
the following attacks occurred : —
( 1 ) Attacks in Persons visiting Rose Street House.
Three households were primarily infected, and five persons sickened secondarily
to them.
Primary. Secondary.
(1) 23 Oxford Lane, - - T., Sickened, 12th Aug. 21st Aug.
(2) 57 Thi.ae Street, ' ■ M., ,. 1^^ f^^^
(3) 248 Ma,thieaon Street, - 0.,/^'°"'™'"' <'> ^°8- ^- <'>
iDiscovered 1st Sept. H., 7th Sept.
The date here assigned to the primary attack at Mathieson Street is subject
to an explanation. This patient was a daily visitor to a non-infected house at 71
Rose Street, for the purpose of tending a child during the mother's absence at
work, and is known to have been present in the infected house during the funeral
service on 11th August, and may have visited later during the husband's illness,
but of this we have no reliable information. Her visits ended on 21st August,
and on the 24th she was seriously ill, according to the mother of the child she
nursed. At this time her daughter, who is indicated on the list of secondary
cases by D. (?), was well. It is only on 1st September that the mother's illness
was known to us, and her daughter was at the same time found dead, and
decomposition was too far advanced to admit of a post-mortem examination being
made.
The other secondary case at Mathieson Street was a neighbour and visitor
of the family G.
(2) Attacks in Persons visiting Thistle Street House.
Six persons were infected, and there were no secondary cases.
■ (1) 6 South Coburg Street, - T.H., Sickened, 23rd Aug.
(2) 57 Thistle Street, - -M'K, „ 28th
(3) 110 South Wellington Street, M.,
(4) 28 Cook Street, - - - D.,
(5) 57 Thistle Street, - - - M'G.,
(6) „ ... - K,
The first patient on this list probably owes his infection to visits to the
Thistle Street household during the currency of the child's illness, rather than to
attendance at her " wake," because he sickened on the day following her death.
This Thistle Street house consisted of two apartments on the first floor (1 up, that
is), " ticketed for four, but occupied at the time by eight adults and one child.
Leaving aside these groups for the moment, there are others which require
consideration, because their association with the " wake " households was in no
case direct, in some it was hypothetical, and in others there was no evidence that
it existed.
(3) Attacks in other Persons associated ivith Pose Street.
vSickened. Removed to Hospital.
77 Rose Street, - - - P. F., 13th August. 29th August.
1 Well Street, - - - J. C, 17th „ 30th „
P. F., a jobbing shoemaker, lived next land but one to the family first
attacked, but was not a visitor, nor with any knowledge of having repaired boots
for the affected household at the time.
J. C. was a frequent visitor to the house next door to the infected one, and
occasionally stayed over night there, but denied having been present in this latter.
His house was on the other side of the river.
28th „ )
'^9th ( ^i^-'^^'^^d in
30th " } Reception-
31st „
1 By Section 378 of the Glasgow Police Act, 1866, any bouse of not more than three
apartments, wliose cnbio contents do not exceed 2,000 feet, may be examined and ticketed to indicate
the number of persons it may legally accommodate. The standard of accommodation was raised to
400 cubic feet for adults by the Amending Act of 1890.
11
(J^.) Attacks in Persons indirectly or donhtfully associated wiJ,h " Wake" Households.
(a) 15.!^ Crookston Street —
M. M'L., a child of 18 months, sickened on 20th August, but suspicion
regarding the nature of the illness was only aroused when the cases at Thistle
Street were recognised. Consequently, she was nursed at home till 6th September.
A girl who had been present at the Rose Street " wake," and was employed along
with the patient R. M. (10), in a hair factory, but was herself unaffected, lived next
door to this child, and occasionally nursed her.
(b) 57 South Coburg Street —
Four cases sickened here between 13th and 14th September. A fatal illness
of six days' duration had commenced on 22nd August in this house, which was
regarded at the time as pneumonia, but had been accompanied, according to
information obtained subsequently from the friends, by painful swellings in
the neck and axilla. This earlier illness should, I think, be regarded as plague,
and the subsequent illnesses occurring in this household as due to the continuance
therein of infection.
(c) 23 Florence Street —
R. M. sickened here on 23rd August, but the nature of her illness was
not suspected till 10th September, when she was removed to hospital. She had
no direct association with either of the plague households, but several fellow-
workers had been at one or other " wake."
(d) 52 Dale Street—
At this address a man (MT.), employed as a furnaceman, sickened on 25th
August with symptoms which were attributed to a simple pneumonia, and
died on the 29th. He was buried on 1st September, his bed being gifted to a
neighbour, who had rendered him some service. The recipient, with his wife and
child, slept thereon, and on 8th September the husband sickened, and was the
first case of plague recognised at this address. On the following day he was
removed to hospital. On the 18th a relation (Mrs. G.), living on the floor below,
and who had visited and assisted in nursing him before his removal to hospital,
sickened, as did also one of her children (M. G.). The man who died here of the
pneumonia in the end of August had friends resident at 248 Mathieson Street,
where, as we know, an illness, ultimately fatal, had begun about 21st August. He
was said to have visited that address about this time, but this could not be
verified.
In none of these cases could direct association with the " wake " households
be discovered. In the Florence Street and Crookston Street cases there was
association with persons not themselves affected, but who had been present at the
Rose Street " wake," and the time incidence of their attacks suggests some manner
of indirect transmission of the infection, which a subsequent illustration (7) may be
regarded as supporting. The cases at 57 South Coburg Street, on the other hand, are
not known to have been directly associated with any " wake " contact, although a
jieighbour and frequent visitor of the Oxford Lane cases, the first of which
sickened on 12th August, was also a visitor at the South Coburg Street tenement. ^
The first attack here was separated from the others by an interval of a fortnight,
which may, I think, suggest that she found her infection outside her home,
although, when the subsequent cases occurred, no record of her movements could
be obtained.
(5 ) Govan Cases.
Meanwhile a case of the disease had occurred in the Burgh of Govan, fatal
towards the end of August, but having no traceable association with the Glasgow
cases.
1 On an earlier statement, that she visited the house of the M, family, some doubt was after-
wards thro^vn.
12
(6) Cases occurring in Hospital.
A baby born in hospital, on 16th September, of a plague mother,
developed cervical buboes 8 days after birth, and died of recognisable plague on
27 th September. Delivery was by forceps, and the buboes developed in the
lymphatics arising in the area subjected to the pressure of the instruments.
A cleaner in the plague ward in hospital sickened of the disease on
13th September, nineteen days after her first exposure, and on the 9th day after
she had received an immunising dose of 10 c.c. Yersin's serum injected sub-
cutaneously. Her attack was of the mildest character, but the bacillus was
recovered from an affected gland.
(7) Transmission of Infection by a Person not suffering from the Disease, hut definitely
exposed to Infection.
Special interest attaches to the following case, because it affords an illustra-
tion of the transmission of infection on the person or clothing of one not suffering
from the disease, although definitely exposed to infection. The importance of this
incident was recognised at the time, and made the subject of a special enquiry.
(See Report in Minutes of Corporation, p. 1452.) It was our custom on
removing the inmates from an infected house to leave everything in situ, and
fumigate with liquified sulphur dioxide for at least twelve hours, and thereafter to
spray surfaces, &c., with formalin or chlorine. Clothing which was to be removed
for further treatment by steam or otherwise was thereafter wrapped in sheets
damped also with formalin. One of our clothes collectors was so employed on
3rd, 6th, and 10th September. Whether he carefully followed instructions regarding
the removal of infected articles may be doubted, as on the 13th September his wife
sickened of plague, an inguinal bubo developing. Their house was far removed
from the other infected houses, and there was no other discoverable or probable
source of infection. I believe the husband carried it on his clothing or person,
although it may be open to question whether the medium was infecting dust or
fleas. The part played by fleas in the transmission of infection is referred to else-
where. The collector, it should be stated, had received an immunising dose of
Yersin's serum.
This, then, represents the distribution of the houses invaded, and it may
make the development of the outbreak clearer if we arrange the cases in groups
according to the order of sickening.
TIME DISTRIBUTION OF CASES.
( 1) 3rd August.
Household at 71 Rose Street is invaded. Two out of four inmates sicken,
and " wakes " are held from 7th to 10th. On 12th a third inmate is attacked,
and a visitor (Mrs. T.), residing at 23 Oxford Lane. The occupant of a neighbour-
ing house (P. F.) sickens on the 13th, and an occasional visitor to an adjoining
house (J. C.) on the 17th.
(£J 19th August.
Two cases begin at 57 Thistle Street, and attacks follow in two members of
the same family, and in six other persons who attended the " wake " here on
21st and 22nd August. The last of these sickened on 31st August.
(3) 20th and 23rd August.
(a) Members of three households, in Florence Street, Crookston Street, and
57 South Coburg Street, sicken. These have had no direct connection with
either " wake," but one (R. M.) was associated im her employment with several
who had attended that at Rose Street. A second (L. M'L.) was nursed occasionally
13
by another contact, while no very definite information can be obtained regarding
the movements of a third (South Coburg Street family) before her fatal illness
developed. It is regarded as plague because of four subsequent cases in the
family.
(h) K contact (Mrs. G.) with Rose Street sickens at 248 Mathieson Street on
the 21st, and before her illness is discovered two others — her daughter and a
neighbour (G. H.) — have been attacked.
(Jf.) 29th August.
(a) A man (M'l.), having relations living in Mathieson Street, sickens at
Dale Street on 25th August, and dies on 29th of a pneumonia. On 8th September
a neighbour (M'M.), who had slept in his bed, sickens, and from this two
secondary cases (Mrs. G., who nursed M'M., and her daughter) sicken on 18th
September.
(b J About this date a fatal illness occurred in Govan. (Case H.)
It was acute in character, fatal on the second or third day, and the nature of
the disease verified by post-mortem examination. This patient had no traceable
connection with the Glasgow cases, and may thus prevent us from holding as
proved the direct line of descent from the Rose Street " wakes " of some, at least,
of our own cases, especially those where the association is of an intangible
character.
(5) loth September.
Clothes collector's wife (Mrs. B.) sickens.
In the following Table all the deaths occurring at home which preceded
recognisable cases are included, but distinguished by letters instead of consecutive
numbering. Case H, however, was, as has been stated, demonstrably plague on
post-mortem examination. In case D, also, the death, although occurring in
hospital, was not at the time regarded as plague. (See Dr. Buchanan's
observations.)
TABLE SHEWING Cases recognised as Plague, and including certain
No.
Name.
Age.
Ytars.
Sex.
Addkess.
OCODPATION.
Date of
Recovery.
M.
F.
Sickening.
EemoTal to Hoepital.
A
Mrs. B., -
57
1
71 Rose Street, - . - -
Fisli hawker, -
August 3,
B
Baby B., -
1
71 do., ... -
„ 3, -
I
J. B.,
60
1
71 do., - - - . -
Dock worker,
„ 12, -
August 27,
2
Mrs. T., -
40
1
23 Oxford Lane, - - - -
Domestic,
„ 12, -
„ 27, -
1
3
P. F.,
56
1
77 Rose Street, ... -
Shoemaker, -
„ 13, -
,, 29,
I
4
J. C,
24
1
1 Well Street, Calton,
Slater's labourer, -
„ 17, -
„ 30,
I
C
C. M., -
9
I
57 Thistle Street, - - -
At school,
„ 19,
5
Mrs. M., -
40
1
57 do., - . . .
Domestic,
„ 20,
August 25,
I
D
Mrs. G., -
55
1
248 Mathieson Street, -
Domestic,
''I
E
M. a,
(Daughter of
Case D).
24
1
248 do.,
Charwoman, -
V
6
D. T.,
7
I
23 Oxford Lane, -
At school.
August 2] ,
Ancyn^t
I
P
CM.,
14
\
57 South Coburg Street,
Cigarette packer, -
22
7
P. M. , -
20
1
57 Thistle Street, - - - -
Slipper maker,
22
August 25,
g
W. M.,
3
1
57 do., ....
„ 23,
„ 25, .
1
9
T. H.,
15
I
6 South Coburg Street,
Nil,
23,
,, 29,
1
10
R, M., -
28
I
23 Florence Street,
Hair worker, -
23
SlpTl'I'PTll rlfP 1 f\
1
11
W. W., -
48
21 Robert Street, Govan.
Painter, -
About 4 weeks
previous to
admission, -
20, -
...
G
G. M'L, -
52
1
52 Dale Street, ....
Labourer,
August 25,
...
12
E. M'L., -
]
154 Crookston Street,
lOCIJLClllUd Uj
1
13
A. M'K., -
12
1
57 Thistle Street,.
At school.
„ 28, -
August 29,
I
14
A. D,,
18
1
Removed from Reception House,
Rivetmaker, -
„ 28, -
„ 29, -
I
15
J. M.,
14
1
Do.,
Millworker, -
,, 28,
„ 29, -
1
16
P. M'G., -
18
1
Do.,
Labourer,
,, 30,
„ 31, -
1
17
Ag. R., -
1
Do.,
Nil,
31,
Septembei"- 3, -
I
jj
Go Vein Boy,
I
18
G. H., -
46
I
248 Matliieson Street, -
Boot-top fitter,
SsAri'f.pTnliPi' 1 ^5 .
19
C. M'M., -
27
1
52 Dale Street, ....
Labourer,
8,-
9,-
1
20
Mrs. B., -
29
1
81 Cubic Street, ....
Domestic,
13, -
14,-
1
21
E. R.,
21
1
Belvidere Hospital, -
Ward maid, -
13, -
14,-
1
22
Mrs. M., -
20
1
57 South Coburg Street,
Domestic,
13,-
15, -
23
Mrs. M., -
41
1
57 do..
Domestic,
14,"
16,-
1
24
Mary M., -
14
I
57 do..
Nil,
14,-
15,-
1
25
R. M., -
12
1
57 do..
At school.
14, ■
16,-
26
Mrs. G., -
24
1
52 Dale Street, ....
Domestic,
18, -
19, -
1
27
M. G.,
6
1
52 do., ....
At school.
18,-
19, -
28
Baby M., -
8 days
Belvidere Hospital, -
24,-
...
X
A. A.,
18
1
3 Moss Road, South Govan,
(Removed from Western Infirmary).
Boilermaker, ■
September 5, -
September 6, -
1
Deaths occureing at Home. These latter are distinguished by Letters.
Deaths in
Nature of association with earlier
Appro.ximate duration of
Incubation.
Nature of attack and site of
External Bubo.
Hospital.
Home.
cases. ^
August 7,
Do. 9,
1st Case of which there is any
\ record,
Death ascribed to Acute Gastio
Enteritis.
Death asciibed to Zymotic
Enteritis.
September 24, -
Husband of A,
Relative, and helped to nurse A ,
Lived in neighbouring tenement
to A,
Slept in house next door to A on
13th August,
Maximum, 9 days,
Do.,
Maximum, 10 days,
4 days,
Right inguinal. Ultimately
Septicseiuic.
Left inguinal, complicated with
Abortion. Severe.
Left inguinal. Severe.
Double inguinal. Mild.
August 21,
At wakes in A's house,
8 days,
Uncertain whither she sickened
simultaneously with her child,
Case C,
Death ascribed to Pneumonia.
Rlrfllt. lIlffnTTlll ^Ci\jcyfa
AVi^iiu iijyillllal. ocvcre.
September 4, -
Found dead
September 1, -
August 28,
At funeral service in A's house,
Child of No. 2,
None known,
10 days,
A possible illustration of infection
from bubonic attack in a
parturient woman, but associ-
aLCLl VVlLli tjiic VVaiit/O,
Death assumed at time to be due
to Typhus Fever.
P. M. impossible owing to
advanced decomposition.
Right inguinal. Mild.
Death ascribed to Pneumonia.
August 27,
Brother of Case C,
Do.,
In C's house during her illness
and wake.
Associated with visitors at C's
house.
4 days,
2-3 days.
Maximum, 4 days.
Neck, axilla, groin, and abdomen.
Septicasmic.
Cervical. Mild.
Cervical, right inguinal and right
femoral. Severe.
Double inguinal. Mild.
October 6,
August 29,
August
History of visits to 248 Mathieson
Street at time of D's illness,
Nursed by associate of visitors
at C's wake.
At C's wake,
Do.,
Do.,
Do.,
Do.,
Maximum, 5 days,
6-7 days.
Do.,
Do.,
8-9 days,
tz-io uayb,
Ultimately Septica3mic.
Death ascribed to Pneumonia.
Right axilla. Mild.
Cervical. Pestis ambulans.
Do. do.
Right axillary. Pestis ambulans.
Cervical. Pestis ambulans.
Right axillary. Pcatis ambulans.
September 13, -
A visitor at D's house,
Slept in G's bed,
Wife of employee of Sanitary
Department,
Maximum, 7 days,
Right inguinal. Ultimately
Septicemic.
Left axilla. Cerebral. Severe.
Right inguinal. Mild.
Posterior cervical. Pestis ambu-
lans. Had Serum previously
September 16, -
_ Household in which Case F.
had died.
16 daj's' interval elapsed between
the first of these cases and
Case F,
Left inguinal, with general septic
infection. Premature labour.
Right inguinal. Severe.
Right axilla. Pustular plague.
Mild.
September 28, -
Nursed Case 19,
9-10 days,
Left axilla. Ultimately Septi-
cemic.
Right inguinal. Mild. Had
Serum previously.
September 25, -
Daughter of 26,
Do.,
Right inguinal. Probably ulti-
mately SepticEemic.
Do. 27, -
7-8 days,
Cervical. Septicajmic.
See pp. 16, 55, and 70.
16
Arranged in weekly periods, the impetus which the infection acquired from
the " wakes " becomes more evident,, and I have placed the whole series in this
chronological order with the view of asking whether it affords any information
regarding the conditions which determine the infectivity of plague.
Number Sickening in Weekly Periods, with Number of Fatal Attacks
Beginning in Each.
August.
Septemter.
Week Ending,
4
11
18
25
1
8
15
22
i
Total.
Number Sickening,
- 2
4
11
8
2
61
36
Number of Fatal Attacks be-
ginning in each week, -
2a
1
6o
2 c-
I
2
2
16
1 These figures include one in each week occurring in hospital.
a Cases A and B.
6 Includes cases C, D, E, F, and G.
c Includes case H.
TYPES OF THE DISEASE.
Professor Zabolotny, of St. Petersburg, who spent a considerable time with us
during the outbreak in a study of the serum-therapy of the disease, has placed on
record his opinion that the outbreak was mild in its character when compared with
those of India, China, and the East generally, and also as compared with the more
recent European outbreaks at Kolobowka and Oporto. Particularly he lays stress
on the picture of protracted illness which the post-mortem appearances presented.
In J.B. death followed only after forty-three days' illness ; in G.H. it
occurred on the tenth day; in the six other deaths occurring in hospital after
intervals of from two to seven days from the onset.
Two of these fatal cases (P.M. and Baby M.) were septicsemic in t3rpe, probably
from the onset ; in the others the septicasmia was secondary, and associated with
the invasion of other organisms.
In all the cases external buboes were present, which varied in situation and
size, and in the degree of involvement of surrounding tissues ; in those designated
pestis ambulans the affected glands were small, and sometimes so deeply seated
that puncture was attended with considerable difficulty.
In one case only were the affected glands not tender to pressure after patient
came under observation (Case D). This patient was, however, comatose on admission.
In another patient, marked X on table, enlarged glands were felt, but pressure
elicited no evidence of tenderness. This case is not included in the list ; but a
special note by Dr. Cairns is appended.^ Clinically it did not differ from a severe
pneumonia ; but doubt existed as to presence of b. pestis in the sputum, and
patient's recovery seemed to discredit the assumption that it was a plague
pneumonia. The probability was only revived when the agglutinative reaction was
obtained, and serum experiments had demonstrated a limited protection in animals,
from inoculation with plague virus.
With regard to the degree of severity of attack, the following classification of
the hospital cases can be made : — Eight were fatal, six were severe, seven were
mild, and seven were so slight as to warrant them being regarded as pestis
ambulans. In these latter the symptoms belonged to the same category as in the
more severe cases ; but they were slightly marked, vanishing, in their mildness.
1 See p. 55, and Table III., p. 70.
17
almost beyond recognition. Save for their association, ^ilague as an explanation
would have been purely conjectural, except by the recovery of the bacillus from the
affected glands. Most of these developed their attacks while under observation
in the reception-house. By contrast, all the deaths occurring at home, and
which are now to be regarded as plague, followed short-lived illnesses. Four
had a definite history of pneumonia. Two had diarrhoeal symptoms. All were
probably septicsemic from the outset. One, when found, had extensive deep-seated
glandular enlargements in the inguinal regions, presented a definite petechial
staining of the skin, and was regarded, provisionally, as typhus fever. This case
was admitted to hospital before death occurred.
The symptomatology as presented by the patients in hospital is discussed by
Dr Brownlee in a subsequent section.
THE CONDITIONS OF SPREAD.
In describing the topographical distribution of the cases we have seen that,
by including unrecognised deaths at home, a more or less tangible thread of
association can be established between all of them, which the time incidence of the
attacks strengthens.
We have now to consider the manner in which this association became
established ; and on this the after history of the wake contacts has some bearing.
The first cases which occurred (A and B) had marked intestinal symptoms ;
and the fatal termination in less than a week suggests that a condition of
speticsemia preceded death. In these cases the p. bacillus is present in the blood.
Linen soiled with the discharges from the patients would retain the infection ;
and it is a fair surmise that the suctorial parasites of mankind are equally cajDable
with those of the rat of abstracting the p. bacillus from the blood of a human
patient where a plague septicaemia exists Of the persons pi'esent at the wakes
here, four afterwards sickened. Among those attending the Thistle Street wake,
six primary attacks resulted. The first illness in the Thistle Street household was
pneumonic in type ; and during the wakes three others of the family were sick, one
of them of plague septicaemia. Seven families altogether were resident at 57
Thistle Street ; but attacks occurred only among those who had been present at
the wakes, although the importance of this may be to some extent discounted by
the recognition of the nature of the disease five days after the death in this
household occurred, and the consequent removal of all the known contacts to the
reception-house.
Some importance also attaches to the new centres of infection created by
the cases who obtained their infection while attending the wakes. The secondary
case which occurred at Oxford Lane had other associations with the wake families,
being a relative; and the two cases marked secondary at Thistle Street were within
the time limit of infection from their sister, who died of pneumonia.
But the patient G.H. (Case 18), whose sickness was definitely secondary to
that of the visitor from Mathieson Street, had no relation with Rose Street,
and owes his attack entirely to the new focus established in the Mathieson Street
household, as, indeed, also does this visitor's daughter, if we assume that her
death was due to plague.
Again, of the primary attacks which followed from the first wake, two out of
four died — three out of five if we include the grandfather's illness — and one who
recovered had a protracted and severe illness ; and of the secondary attacks
developing in the new centres of infection thus formed, three deaths again occurred
out of five attacks. In this connection it is to be observed that severity of attack
in those called primary infections was supplemented by prolonged exposure at
home on the part of those who sickened secondary thereto.
18
In contrast with this is the record of attacks which followed the second wake.
Here only one was severe in character, and there were no secondary attacks. But
it is to be remembered that by this time we had become alive to the fact that we-
were dealing with plague, and an active search for the discovery and segregation of
contacts had begun; and so it happened that four of these primary attacks
developed under observation in the reception-house. A fifth was under observation
at home, and was removed to hospital on the day following sickening ; while the
sixth, the only severe one, had sickened on August 23rd, but remained at home
till the 29th, when the nature of his illness and his association with the Thistle
Street cases were first known.
It may be that there is an important lesson in this, could we read it aright.
The first wake was held in a dirtily-kept one-apartment house, in which a child
was dead after four days' illness, and a woman after seven. The second wake
followed an illness of two days' duration ; but the type was pneumonic, and three
others of the family were already sick or sickening, one of them of an attack which
was to prove fatal in a few days. Save in the existence of a second apartment, this
latter house was like the other. Either would have offered an excellent breeding
ground for typhus fever. But all the first wake contacts sickened in their own
houses, and for days remained there undiscovered. Thus not only was their
infection contracted, but the wdiole of their incubation period was passed in the
foetid atmosphere of ill-kept dwellings. On the other hand, before the incubation
period had passed for those attacks which resulted from the second w^ake, four of
them had been removed from the squalor of their homes to the cleanlier conditions
of a recejotion-house ; and these attacks were so mild that, save for the circum-
stances under which they occurred, they would never have come under medical
observation at all. Indeed, the analogy of smallpox, modified and defaced, as it
were, by almost protective vaccination, was forcibly suggested by these mild
attacks of plague.
I am disposed to connect the mildness of these latter attacks with the healthier
conditions under which j)art of their incubation period was passed, although the
numbers are too small to encourage any attempt to overweight their importance.
But as the clinical histories of the patients in hospital developed, and it was
possible to learn something from j>ost-mortem examinations of the causes which
were at work in producing the fatal issue, it began to be recognised that plague
not only powerfully predisposes to septic complications, but that some form of
double-infection might, indeed, possibly be present almost from the beginning.
Whatever be the significance of this, it remains as an observation that none of
the attacks which developed at home were so mild as those occurring among
contacts in the reception-house. So mild, indeed, were these latter that it was
difficult to regard them as constituting elements of danger at all to persons in
healthy surroundings.
In the whole range of plague literature, no feature in the spread of the disease
is more uniformly insisted upon than its association with local conditions of grossly
defective hygiene. Indeed, it is from this circumstance that the belief in an
autochthonous origin of plague arose ; and, without subscribing to the theory, we
may accept the facts on which it is based as of the first importance. But there is
something more to be considered. By what means do locally defective conditions
become operative in the spread of plague ? In other words, is the potency of
plague infection determined by the conditions of exposure to it ?
At first it would seem as if this implied the need to distinguish between
susceptibility on the part of the individual and the conditions under which exposure
to infection takes place; but many things point to this latter as forming the
dominant factor in determining an attack. The inmates of an infected dwelling,
under certain conditions, also contract the disease ; the occasional visitor rarely, if
at all. Of the gang of dustmen engaged in carrying out disinfection in Bombay,
only those contracted the disease who lived in houses of bad sanitary condition.
19
Here susceptibility to the disease would seem to have b^n induced by conditions
ejusdem generis with those which favour its spread. An opposite, and quite the
most interesting, illustration of its kind which I have found, is that described by Dr.
Cantlie. ^ Eight Chinese students of the College of Medicine in Hong Kong were
engaged, during the outbreak there, as ward attendants and clerks in the plague
wards for a period of six weeks, and they shared the immunity enjoyed by
Europeans at a time when their relations, living at home, were being attacked.
They lived, however, and worked under conditions which afforded little opportunity
for the plague virus becoming concentrated, and to this their protection may be
attributed.
With this illustration we may, I think, dismiss from consideration any
argument based on immunity from infection enjoyed under corresponding
conditions of exposure. It is true that one of our ward cleaners contracted the
disease in a mild form — cultivation and inoculation experiments with the dust of
the ward were at the time, unfortunately, impossible — yet the statement, I believe,
holds good that plague, even more than typhus fever, may be handled with
comparative immunity under the conditions obtainable in hospital wards; but that
it may be conveyed on the person or clothing of one who has been definitely
exposed to infection, but is not ill of the disease, the attack on the wife of our
clothes collector also demonstrates. And here there was neither the individual
susceptibility which unhygienic conditions of living creates, nor the simultaneous
exposure to infection, and the conditions favourable to its spread at a point where
both existed. This attack also was mild in type. There was no superficial abrasion
of the cuticle to indicate the point of entrance of the infection, so that inoculation
by infectious dust may presumably be excluded. But the houses of the majority
of the cases were hotbeds of vermin, and the clothes collector, like all those who
had to deal with the infected houses, frequently complained of the annoyance these
insects caused him. He had received an immunising dose of 10 c.c. of Yersin's
serum before beginning plague work.
It may be that some of the cases which we have regarded as arising from
indirect contact owed their infection to quite a different source — to a strain of
infection kept alive through a series of cases of pestis amhulans, which the most
diligent search failed to discover. The attack of the clothes collector's wife,
however, introduces a new aspect into our conception of what contact implies. It is
not necessarily contact with infectious sick, or with their exhalations or discharges,
but with infection retained in the secretions of an insect, which has obtained it
from one or other of these.
In two of those which have been called indirect (P.F. and J.C.), the association
was not with persons at all, but with locality ; and these are the only two which
suggest radiation of the infection beyond the invaded households by means other
than personal intercourse. One, we have seen, slept next door to the house at 71
Rose Street four days before sickening, and the other lived near by and worked
as a jobbing shoemaker, with his workshop attached to his house.
The death from pneumonia, which preceded the recognised illness at Dale
Street, occurred in a man who had been visiting 248 Mathieson Street, where the
attacks were septictemic ; but in the following instance there is a suggestion that
the plague organism passed into a state of saprophytic existence, and thereafter
acquired renewed virulence, or maintained it in some way not presently demon-
strable. In the cases to which I have already referred as occurring at 57 Coburg
Street the attacks develoj^ed, one on the 13th and three on 14th September, the
earlier and one of the latter being fatal, one being a parturient woman, and the
other a mixed infection. We have seen that a death occurred here on 28th
August, from an illness which began on the 22nd, and which was probably plague
pneumonia. An interval of sixteen" days thus elapsed before the next sickening
1 See Transactions Epidemiological Society, vol. xvi., p. 24.
^ An incubation period of fifteen daj's was observed during the Hong Kong outbreak.
20
occurred, and this is rapidly followed by attacks in all the remaining members.
What was happening in the interval between the first death and the next
sickening ? So far as we could learn, these last four had been exposed to no new
source of infection outside their dwelling. The house was on the third floor of a
four-storeyed tenement, housing sixteen families. The focus of infection must have
been strictly localised, as no other household in the tenement was affected. Apart
from a knowledge otherwise obtained, one might infer from this alone that the rats
here were not infected. It may be that the virus remained in the bed or body
clothing, which had been soiled during the first fatal illness, or in the dirt which
prevailed everywhere ; but laboratory experiment would seem to show that after
fourteen days artificially infected material loses its virulence if kept at air
temperature. (See earlier reference to question of transmission by fleas).
It may have been a coincidence ; but one of these cases was the sole example
of pustular (cutaneous) plague which occurred, the first vesicles appearing under
the right shoulder blade. (Case 24.)
The small number of plague contacts who develop the disease while under
observation has frequently attracted notice. In the segregation camps of India, in
Sydney, and elsewhere, the experience has been the same ; and the inference
usually drawn is that the direct source of infection is in the surroundings rather
than in the patient. This, I think, is partly true, although we have seen that the
Bombay dustmen required more than exposure to the infected house to produce
the disease in them. Those who were attacked had been rendered susceptible by
residence in unhealthy surroundings.
But there is a sense in which the type of attack in the individual may be said
to determine the infectivity of his neighbourhood. Variation in type, indeed,
appears to be more important than variation in severity of attack. The
pneumonic patient may eject the bacilli into the air, and the septicsemic afford
facilities for the transmission of the disease by insects. Wherever this form was
present during treatment at home, secondary cases followed. This was seen in the
deaths which, at the time of their occurrence, were unrecognised, and from 71
Rose Street, 57 Thistle Street, 57 South Coburg Street, and 52 Dale Street,
dissemination of the disease also took place.
But in Well Street, 77 Rose Street, Florence Street, Crookston Street, 6
South Coburg Street, Cubic Street, and in the Govan patient (H.), no secondary
infection followed, although intervals varying from one to nineteen days elapsed
between sickening and removal of the patients to hospital. These, save the Govan
case, might be called bubonic in type. Forty-five persons were known to have
visited the six Glasgow patients just noted. All of them escaped infection, and the
opinion expressed by Montanus, and quoted by Boghurst, that a slight plague
infects not " unlesse a body bee extremely fitted to receive it," has quite a modern
illustration.
21
ADMINISTRATIVE MEASURES.
The recognition of the disease created a new problem for the sanitary
administration, and made it necessary to recast several of the executive methods.
The outbreak at Oporto in the previous year had led to increased activity on
the part of port sanitary authorities, with the view of arresting the introduction of
the disease through shipping. The geographical position of Glasgow, however, places
it at a disadvantage in this respect. Within its own municipal area it is unable to
protect itself against sea-borne infection ; and the occurrence of indigenous plague
in the only considerable port of the country which has no constituted port authority
is suggestive. Such limited examination of ships and crews from infected ports
as, in the circumstances, was possible, had been conducted during the year ; and
a record was kept of foreign-coming passengers who had entered the country in
infected ships through other ports in the kingdom. In no case was any illness
discovered suggestive of plague ; and none of the passengers who had come off
infected ships resided within the infected area.
The occurrence of the cases without any traceable connection with the soux'ce
of infection made domiciliary visits, with a view to the discovery of others, a first
necessity ; whilst the facilities which bad hygienic conditions were known to afford
for the spread of the disease made the introduction of a higher standard of
domestic cleanliness in the neighbourhood of the infected houses second only in
importance to this. Fortunately, the means by which the latter could be enforced,
and the former object accomplished, lay to hand in Section 254 of the local Police
Act of 1866, which owes its origin to the typhus fever prevalences in the middle
of the century. 1 It supplied a lever by which practically anything which could be
regarded as affording a suitable nidus for the saprophytic existence of the plague
organism might be speedily exorcised ; and I am inclined to regard it as one of the
most valuable statutory powers we possess. It brought the limewasher and
scavenger into active co-operation with the housewife, and established for dirty
areas " spring cleaning " on a fairly extensive scale.
In view of the possibility of a rat infection, the condition of disused basement-
flats, cellars, and the like became important ; and this clause was extensively
applied in procuring the cleansing of such places.
An emergency meeting of the Magistrates Committee and of the Committee
on Health was held on 31st August, and the following extracts will indicate the
line of action recommended and approved thereat : —
The Medical Officer of Health reported that in the district of the city bounded by Cumberland
Street on the south. South Wellington Street on the east, Adelphi Street and Carlton Place on the
north, and Bridge Street and Eglinton Street on the west, plague or similar epidemic disease exists in
such district, and that it would be desirable to use special sanitary measures in order to prevent the
spread of such disease ; and the Magistrates Committee, having considered said report, approved
thereof, and remitted to the Medical Officer of Health to forthwith enforce the provisions of Section
254 of the Glasgow Police Act, 1866, within the said district.
1 " On a report by the Medical Officer that in any district, street, or court it would be desirable
to use special sanitary measures in order to mitigate the severity, or prevent the spread of epidemic,
endemic, contagious, or other disease, or that any such disease prevails, or exists, and threatens to
prevail, in such part of the city, the Magistrates Committee may approve tliereof ; and on such an
approval it shall be lawful for the Medical OlBcer to give notice, in manner hereinafter provided, to
the proprietor or occupier of any dwellingdiouse situated in the p.irt of the city in which the Medical
Officer has reported that it appears to him desirable to use special sanitary measures, requiring such
proprietor to cleanse and limewash the outside thereof, and the common stair and lobbies and
staircases, and requiring such occupier to cleanse and whitewash the interior thereof, and to purify,
ventilate, and disinfect the said dwelling-hous^, or any apartment or apartments, or bedding or
clothes therein." — Glasgow Police Act, 1866, Sec. 254.
The Medical Officer of Health explained to the Joint-Committee that he proposed that the
following line of action be immediately adopted in dealing with the existing state of matters, viz. : —
(1) ( a) That in each land fi-om which a case is removed the lobbies, staircases, common passages,
and each house be disinfected and cleansed by the Sanitary Department — the
Cleansing Department making special arrangements for emptying and cleansing
ashpits and hosing out courts ;
(h) That tenements from which "contacts" are removed be dealt with similarly to the
foregoing ;
(2) That the district above defined be constituted a special cleansing area, the provisions to
include a thrice-weekly emptying of ashpits, limewashing thereof, hosing of courts,
special removal of rubbish, &c. ;
(3) That medical inspection of the district be organised and carried out by the medical staff of
the Sanitary Department, with the addition of two duly qualified and suitably experi-
enced medical practitioners, and that inoculation with anti-plague serum be offered, free
of charge, where deemed advisable ;
(4) That a special sanitary inspection for dirty stairs and houses, and for overcrowding of houses,
be instituted ;
(5) That ratcatchers be employed for service, where deemed necessary, within the said district ;
and
(6) That a handbill be posted within the district directing the attention of the pirblic to the fact
that immediate medical attention may be had from the Sanitary Department on com-
municating therewith through the nearest police office or station.
The Joint Special Committee approved of the foregoing operations proposed by the Medical
Officer of Health, and directed the Sanitary Inspector, the Superintendent of Cleansing, and the
Chief Constable, and all other officials interested, to act in constant co-operation with the Medical
Officer of Health in fully and efiectually carrying out the said proposals, and safeguarding the public
health.
The Joint-Committee agreed to recommend that it be remitted to the Medical Officer of Health,
the City Engineer, the Sanitary Inspector, and the Clerk, to enquire as to obtaining further suitable
and adequate reception-house aceoaimodation, and to report on the result of their enquiries to the
Lord Provost and Councillor James Dick, with power to the latter members of Committee to authorise
the acquisition of such additional reception-house accommodation.
The Joint-Committee resolved to propose, at a special meeting of the Corporation as the Local
Authority under the Infections Disease (Notification) Act, 1889, which special meeting the Lord
Provost had directed to be convened for Tuesday, 4th proximo, at 1.30 o'clock, the following
resolution, viz. : — ''The Corporation, as Local Authority for the City and Royal Burgh of Glasgow
under the Infectious Disease (Notification) Act, 1889, declare, in terms of Section 7, Sub-section 6, of
said Act, that emergency arises in consequence of the existence within the city of certain cases of
plague, and therefore order that said Act shall, in the district of the said Local Authority, apply to
'Plague,' and that for the period from the expiration of one week from the date of the advertisement
to be made in terms of said Act till the 31st day of December, 1900."
The scheme of action thus outlined was carried into effect in the manner
described in the following extract from the Report of the Medical Officer to the
Health Committee on 10th September following : —
The scheme of action approved of at the special meeting of the Magistrates Committee and the
Committee on Health, held on 3)st August, is being carried out in the following detail in the defined
area, and, as then authorised. Dr. Frederick Dittmar and Dr. Alfred Webster have been added to
the staff : —
( 1 ) Within this district special cleansing operations are being conducted in the following detail : —
(a) Ashpits are being
(1) emptied three times a week, and
(2) washed once weekly with " chloride of lime whitewash" (1 lb. "chloride
of lime " added to 12 gallons of freshly-slaked lime solution of the con-
sistency of milk).i
(6) Back courts in dirty condition are hosed every night with "chloride of lime"
solution, 1 in 100 (1 lb. "chloride of lime" to 10 gallons water). [For this
solution " chloros " was afterwards substituted, owing to a mechanical difficulty
in the distribution of the " chloride of lime " mixture.]
(2) A special inspection of the district is taking place for the detection of dirty houses, closes, &c.,
and for overcrowding of houses.
(3) Infected tenements, and, if necessary, those where "contacts" reside, are being dealt with
as in (8).
1 To secure uniformity in the strengtli oi tlie caustic lime solution, the proportions specified in tlie Venice Convention
"Were subsequently substituted, viz., 10 lbs, of dry lime to 3i gallons of water.
23
(i) Medical inspection of the district is being carried out ; the ocrapants of the infected tene-
ments, and all "contacts/' are oflfered inoculation with Yersin's serum, and others in
neighbourhood with Haflkine's prophylactic. Suspected cases are being seen with the
medical attendants.
(5) Plague has been added to the Infectious Disease (Notification) Act, 1889.
(6) Handbills are being distributed offering the services of the medical staff at any time, on
application to the nearest Police Office.
(7) Efforts are being made, through co-operation with the surgeons of the shipping companies, to
arrange for medical inspection of Lascars and other crews of ships from infected countries.
(8) The detailed arrangements for the removal of cases and disinfection of infected tenements
are under the personal supervision of one of the medical staff, and may be detailed as
follows : —
(a) l!emoval of patient to hospital.
(b) Removal of "contacts" to reception house.
(c) Fumigation of infected house by liquified sulphur dioxide from 12 to 2-1 hours,
the disinfectant being used in proportion to the cubic space dealt with.
id) After the fumigation the house is entered; all articles of clothing, &c., to be
removed, are first of all thoroughly wetted with 2 per cent, solution of formalin
(1 gallon 40 per cent, solution formaldehyde to 50 gallons waterj, then wrapped
up in sheets soaked in the same fluid and removed to the Sanitary Wash-house.
There all articles which cannot be boiled or steamed, or treated with formalde-
hyde, are burned.
(e) The walls, ceiling, flooring, wood work, &c., of the infected house are also sprayed
with the formalin solution (1 gallon to 50 gallons water).
(/) All houses in the infected tenement are cleansed by the Department ; the lobbies,
stairs, and closes being dealt with by formaldehyde or "chloride of lime"
solution.
ig) Courts of such tenements are watered with "chloride of lime" solution.
(h) Ash-pits have contents watered with same and then removed and burned.
(9) Clinical demonstration of cases in hospital is given daily.
(10) A pamphlet descriptive of the varieties of the disease has been prepared for circulation
among practitioners.
(11) The co-operation of hospital and other dispensaries for the detection of doubtful glandular
affections has been invited.
(12) Mats. — Ratcatchers have been employed, and the existence of disease in rats is being
enquired into.
A circular has been issued to hospitals and dispensaries intimating the presence of plague, and
directing the attention of the medical staff to the need for carefully scrutinising all suspected persons ;
and one also to shipowners impressing upon them the desirability of having the crews of ships arriving
from suspected ports abroad kept under medical observation while in port.
******** -X-*
Detail of Disixfection.
In some of the houses which have had to be dealt with there were some few fabrics which could
only be disinfected by some germicide in gaseous form ; and for this purpose formic aldehyde is being
added to the details formerly stated. An epidemic inspector has also been set apart to supervise,
under the directions of the medical staff and of the district inspector, the carrying out of the details
of cleansing which in those cases is a necessary complement of the process of disinfection.
QUESTION OF GLANDULAR AFFECTIONS.
We knew from our death registers that acute king diseases were not unusually
prevalent — that, indeed, no class of disease existed causing death in such numbers
as to suggest the prevalence of unrecognised plague ; and the services of the
various hospital and dispensary staffs were enlisted with the view of discovering
whether ill-defined forms of glandular affection, Avith fever, were present in unusual
number among the persons attending for treatment. The result of this also was
negative.
24
CIRCULAR LETTER TO DISPENSARY PHYSICIANS.
Sanitary Department,
23 Montrose Street,
Glasgow, 8th September, 1900.
Dear Sib,
PLAGUE.
Will you allow me to bring under your consideration the advantage which will
result at the present juncture to the sanitary administration of having the active co-opei'ation of all
hospital and other dispensaries in the following direction.
Those who are familiar with the recent literature of plague will have prominently before them
the almost uniform record of glandular enlargements of an indefinite character which have preceded
outbreaks of the recognised disease. Sir Richard Thorne, for example, in his last report remarks : —
"Fever with glandular swellings prevailed in Bombay before it was recognised that plague had
reached that city; and it is impossible to read the medical history of this disease in almost every
part of the world without being impressed with the frequency with which recognised plague has been
preceded by ailments of such slight severity, involving some bubonic enlargement of glands, and some
rise in body temperature, as to mask the real nature of the malady."
With this experience elsewhere, and the presence of recognised cases of plague in hospital, there
will, I think, be a distinct public advantage if the attending physicians of dispensaries will carefully
scrutinise all glandular affections of doubtful origin, with the possibility of their association with
plague in view.
I need hardly add that every assistance which can be rendered by the medical staff here will be
at your disposal.
Yours truly,
A. K. CHALMERS.
In carrying out the house-to-house visitation, the medical inspectors made a
wide circle of inspection of persons residing round infected and contact tenements ;
and practitioners generally rendered valuable service by bringing doubtful illnesses
under scrutiny. In addition, the inspectors for the discovery of dirty houses
reported any illness not medically attended, with a view to these being visited by
the medical staff.
Many of the cases which were thus brought under scrutiny could be definitely
excluded on an examination of the symptoms and history of illness ; but several
were removed to hospital for observation, and the most interesting are detailed in
the third interim report.^ Our experience was that septic conditions of glands
were those which most closely simulated plague. In all recent^ cases the absence
of the bacillus pestis from fluid obtained by puncturing the affected gland set the
question at rest. The serum-reaction with a fresh culture of the bacillus has in
this respect also a definite value after the first week of illness.^
Reference is elsewhere made to late information which was obtained of the
arrival in Glasgow, early in the summer, of a vessel trading with plague-infected
ports in India, among whose crew there appeared, during the passage from London
to Glasgow, a glandular affection accompanied by fever ; and the following circular
resulted in a voluntary arrangement by which the crews of all such vessels were
kept under medical supervision while in port : —
CIRCULAR LETTER TO SHIPPING AGENTS.
Sanitary Department,
23 Montrose Street,
Glasgow, 8th September, 1900.
Dear Sir,
PLAGUE.
Circumstances which have come to my knowledge render it extremely desirable, in
the interests both of the shipping of the port and of the community generally, that the crews of ships
from plague-infected ports should, under present circumstances, be placed under a system of medical
surveillance while in port here. This, I believe, may best be accomplished at present by the custom
being generally adopted which obtains in certain firms of arranging with individual surgeons who
might act in co-operation with this department.
I shall be glad to hear from you on this suggestion at your earliest convenience.
Yours truly,
A. K. CHALMERS.
1 Page 36.
= See Dr. M'Olure, p. 57.
^ See Dr. Cairns, p. 67.
PUBLIC NOTICE.
WAKES.
The Lord Provost and Magistrates have had under consideration tlie prominent part which has
been pLayed by the Iiolding of wakes over the dead in the recent visit of plague, and woidd strongly
urge upon the public the necessity and the duty of discontinuing the custom. These ceremonies,
while meant to be acts of friendly remembrance, are fraught with danger to the health of all who
take part in them, and thus to the well-being of the community at large.
They would also remind the public that it is illegal to hold a wake over the body of a person
who has died of any infectious disease.
By Order.
J. LINDSAY, Int. Clerh,
Corporation Police Department.
City Chambers, 12th September, 1900.
Sanitary Chambers,
23 Montrose Street,
Glasgow, 22nd October, 1900.
CIRCULAR LETTER TO THE KEEPERS OF SEAMEN'S AND EMIGRANTS'
LODGING OR BOARDING HOUSES.
Sir,
The recent occurrence of several cases of plague in the city possesses a special interest
to all connected with shipping, and particularly to those who are in daily association with emigrants
or seamen.
Plague can be introduced by persons who, although suffering from the disease, can undertake
journeys of a considerable distance, and it may be so mild that, unless the symptoms are specially
examined by a doctor, its presence may readily be overlooked.
As long as plague is present in foreign countries, there will exist a pressing necessity for care-
fully examining every illness in per-sons coming therefrom, and the possibility of its occurrence
among persons of this class should be constantly before you.
The Public Health (Scotland) Act, 1897, imposes on common lodging-house keepers the duty
of informing the Sanitary Authority of the occurrence of infectious disease in any of the inmates of
these houses. It is also provided in Bye-law 25 of those applicable to common lodging-houses that
"If any person or persons in a common lodging-house shall become ill, the lodging-house keeper
shall at once ascertain from a legally qualified medical practitioner whether the said person or persons
are affected with fever or other infectious disease.'' Should the illness be of this character, the
lodging-house keeper is bound to inform the Officers of the Sanitary Department thereof. Neglect
either to obtain medical advice in these circumstances, or to inform the Sanitary Department of the
existence of infectious disease, renders the keeper liable in a penalty of five pounds (£5).
Plague is now added to the list of infectious diseases under the Notification Act, which also
places on the householder the duty of intimating the occurrence of any infectious disease to the
^Medical Officer of Health.
Communication with the Sanitary Chambers and with the Medical Officer of Health may at any
time be obtained through the nearest Police Station.
Yours truly,
A. K. CHALMERS, M.D ,
Meuical Officer of Health.
DISINFECTION AND EVACUATION OF INFECTED HOUSES.
On the recognition of each case the unattacked members of the family were
removed to a reception-house, together with every visitor who could be traced.
Disinfection of the infected house was thereafter carried out in the manner already
detailed ; and every house in the tenement was similarly treated — papered walls,
surfaces of furniture, &c., being sprayed with formalin, while to unpapered walls,
lobbies, staircases, &c., the chlorinated lime solution was applied. The houses of
contacts were dealt Avith in a similar manner ; and the application extended to the
whole tenement in this case also, where the character of the tenants rendered this
•desirable. On the completion of these processes of chemical disinfection, the
evacuated houses were unoccupied until the dismissal of the inmates from the
reception-house, and the windows left open, in order that complete aeration of
the interior might be accomplished.
26
Disinfection in practice, however, has many meanings and many requirements.
A room with well-plastered walls, solid, and with no crevices into which dust might
drift and insects find a hiding-place, with the flooring good, and the seams between
the boards not gaping, is easily disposed of; but where the plaster is old, blistered,
and broken, the laths uncovered in places, and the flooring irregular and with
gaping seams, the possibility that disinfectants will reach the crevices in which
dust gathers and infection may lodge is a remote one, and it must be remembered that
the possibility of a saprophytic existence of the bacillus of pest has been entertained.
Standing in the middle of such a room from which a plague pneumonia had been
removed, the question which pressed for answer was, can any form of liquid or
gaseous disinfection accomplish its object, the method of applying it, and the place,
being taken into account ? To get at the crevices you must remove the plaster,
and broken flooring can only be dealt with by getting it up and turning out the
deafening, and the process of disinfection is finished only when complete renoVation
of the interior is accomplished. The problem in this form was placed before the
owners of all the invaded houses ; and, without exception, they willingly acquiesced
in completing the work which chemical disinfection may be said only to have
begun.
SUPERVISION OF CONTACTS.
The segregation in the reception-houses of persons who had been in association
with the infected houses was accomplished without having recourse to the statutory
powers existing both in the Public Health (Scotland) Act, 1897, and in the local
Police Act, for removing them under warrant. During the period in which they were
under observation there, but especially when they were dismissed and had returned
to their homes, some apprehension existed, and was occasionally expressed, that the
freedom of intercourse with the general public permitted to them was attended
with risk of spreading the disease. This in the circumstances was natural ; but
these persons were not sick, and consequently were not infectious. In cholera an
attack may be ushered in with uncontrollable vomiting and diarrhoea, which would
establish a focus of infection at the point of seizure. There was nothing in plague,
as we saw it, similar to this, so that, after washing their clothing and the use of a
bath, our reception-house inmates were allowed to attend their work in the usual
way ; but living in a reception-house instead of in their homes, and under daily
medical examination. There was no evidence that the freedom allowed them was
prejudicial, although, with a different type of disease predominating, the practice
might require to be revised.
Rats were numerous in many of the infected tenements, and in those in which
the type of the disease was pneumonic or intestinal, opportunities of infection, in all
likelihood, occurred. On the recognition of the cases, inquiry failed to discover any
evidence that rat-mortality prevailed to an unusual extent ; and when a definite
system of examination was begun, nearly three hundred, killed by trapping, or found
dead in ashpits or elsewhere, chiefly within the area of infection, were bacteriologi-
cally examined without evidence of pest being discovered in any of them. Various
efforts were made to accomplish their destruction by some means more expeditious
than trapping. Rats can be driven from their haunts most readily by the fumes of
sulphur dioxide ; and when escape is impossible, as in the hold of a ship, they
readily succumb to its action. In a simple system of sewerage it is possible, as
was done at Belvidere Hospital, to rid the drains absolutely by such means j with
a more complex system, the difficulties might well tax the resources of ingenuity,
as when means of escape exist, the rats are only dispersed. Indeed, one of the
chief difficulties in dealing with rats arises from the intelligent apprehension
displayed by them of efforts to accomplish their destruction. A few may be killed
by poison or by trapping, but the majority migrate. Sick rats, indeed, are deserted
by their fellows. If they are already plague-infected, their dispersal would seem
27
doubtful policy ; and their destruction can at best only be partial. With the view
of procuring their extinction in one of the hospitals, Danzy's serum was experi-
mentally fed to them, in the hope that the results might lead to its more extensive
use ; but it quite disappointed expectation. None of the rats to whom it was fed
died; and of two which were inoculated with it, only one succumbed to the
infection.
VENICE CONVENTION.
The present Convention is in force for five years from the date of its
ratification, which, for the majority of the signatory governments, was 1898. It is
renewable quinquennially " on the same condit ions ; " and this suggests con-
sideration of some of its requirements, because non-compliance with them by the
government of an infected country cancels the obligation of the other governments
to restrict the precautions against infection, stipulated in the Convention, to the
shipping coming from that part of a country which is declared to be infected. In
the following letter these difficulties are explained at length, and it was made
the basis of a representation to the Local Government Board : —
[Copy.]
Sanitary Chambers,
Glasgow, ITtli October 1900.
John Lindsay, Esq.,
Interim Clerk of Police.
Dear Sir,
PLAGUE.
CIRCULAR LETTER FROM LOCAL GOVERNMENT BOARD, 4th OCTOBER, 1900,
Enclosing Copies of Chapters 2, 3, and 4 of the Venice Convention.
Will you allow me to return to the subject of our conversation some days ago concerning the
phrasing of Section page 6, of the above quotations from the Venice Convention. The terms used
suggest the conditions of a contract, the object of the contract being to prevent the introduction of
plague, while securing a minimum interruption to commerce. Certain minimum restrictions, it is
agreed, shall be imposed by tiie governments of non infected countries in the event of plague
appearing in any of the other countries represented at the Convention. But the obligation to
restrict interference to this minimum standard is dependent on the government of the infected
country taking measures to prevent tire exportation from its infected area of articles declared
susceptible. These articles are described in Section 4, Chapter II. , of the Convention. The inference
seems to be that, if this condition is not complied with, the non-infected countries may impose
restrictions on persons and goods coming from any port of the infeetid country, and not only on
those from the area which may be infected. We were agreed that the "government ' referred to in
Section 3 is, in present circumstances, the Imperial Government, but if you refer to page 2 of the
Local Government Board circular, accompanying these extracts, you will find it stated that on Local
Authorities rests the burden of giving practical effect to the conditions under discussion. Section III.
(Chapter II. of the Convention) appears to base tlie restricted enforcements of these precautions by
non-infected governments on the stipulation that exportation of susceptible articles from the infected
area shall be prevented, but it is also stated that the information which the governments of infected
countries must communicate to the others shall include a description of tlie measures taken regarding
the departure of ships as well.
Dealing first with the question of susceptible articles, I beg to enclose you copy of a letter which
I forwarded to the Local Government Board on 28th September, in which the possible application
for this purpose of Sections 16 (G) and 50 (1) (o) of tlie Public Health Act is discussed, and its prac-
ticability set aside.
If my reading of these sections is correct, we are unable to give effect to one condition of the
Venice Convention — that is, we have no power to prevent the exportation of articles which cannot be
defined as a "nuisance" or certified as "infected."
28
The question regarding the examination of persons leaving port in an infected area may be
considered on a somewhat different footing. It is referred to in Chapter II., Section 1, as one of the
items of information to be communicated to other governments, but the " measures to betaken in
Europe" do not, as I read them, include medical examination of passengers and crews and disinfec-
tion of non-infected out-going ships by a sanitary authority situated as we are at the present moment.
This opinion I have already stated to you in my letter of 10th inst. , but the question is of consider-
able importance to commerce, and the absence of any system of inspecting the passengers and crews
of all out-going ships may be interpreted abroad as a violation by us of the terms of the Convention.
As you are aware, the Health Committee lately approved of a voluntary agreement by which I under-
took to examine the crews of certain ships, but this is only possible through the courtesy of the
shipowners and the acquiescence of the crew, and its scope is very limited. If either must be
done to fulfil the terms of the Convention, do statutory powers exist enabling us to do so ? Section
45 of the Public Health Act is quite specific where there is reason to believe that infectious disease
exists, but can reasonable grounds for entry and inspection be alleged in the case of every ship
leaving an infected port ?
If my observations on the legal aspects of these questions commend themselves to you, may I
suggest that the matter be brought undsr the consideration of the Health Committee, with the view
of their presenting to the Local Government Board a statement of the difficulties which exist in
Local Authorities giving effect to two conditions of the Venice Convention.
Yours truly,
(Signed) A. K. CHALMERS.
BACTERIOLOGICAL AND PATHOLOGICAL REPORT ON THE CASES
OF PLAGUE IN BELVIDERE HOSPITAL IN AUGUST, 1900, BY
ROBERT MUIR, M.D., PROFESSOR OF PATHOLOGY, UNIVERSITY
OF GLASGOW.
In accordance with the request of the Pubhc Health Committee, conveyed to
me by Dr. Chahners on Monday, August 27th, I have investigated the bacteriology
and pathology of the cases of suspected plague in Belvidere Hospital, and beg to
report as follows. (A Preliminary Report was communicated to Dr. Chalmers on
Thursday, August 30th.)
In making these investigations my endeavours were directed, in the first place,
to the separation and cultivation of the special bacillus from the cases, and, in the
second place, to the determination, by scientific methods, of its identity with the
bacillus of bubonic plague. In addition, I performed the 2^ost-mortem examination
in the case of P. M. on Tuesday, August 28th, and have to state in brief the results
of that examination.
In summarising the results it will be convenient to place them under the
following three heads : —
(I.) The characters of the bacillus isolated in pure culture — is it the bacillus
of bubonic plague ?
(II.) The presence or absence of tbat bacillus in the various cases examined.
(III.) The pathological changes in the body of P. M.
I. The bacillus, cultivated, in the first instance, from P. M. during life, was
examined as regards the following characters : —
(a) Structural Characters and Staining Reactions.
Under this heading may be mentioned size and shape, grouping in various
cultures and in the tissues of the body, absence of motility, presence of polar
staining, decolorisation by Gram's method, production of involution forms under
various conditions, absence of spores, &c.
(b) Cultural Characters.
These were studied in various media, including agar, Haffkine's salt-agar, blood
serum, peptone-gelatine, and bouillon.
29
(c) Pathogenic Effects in various Lower Animals.
As regards the various points enumerated under the above headings, the
organism was found to correspond in every particular with the bacillus of bubonic
plague; and I may especially state that the pathogenic results of the plague
bacillus were reproduced in animals by inoculation with the pure cultures obtained
from the human subject.
The result of these investigations is to demonstrate that the organism in
question is without doubt the bacillus of bubonic plague.
II. I have examined nine cases bacteriologically. For this purpose I have
punctured the affected glands, and have examined the fluid obtained both
microscopically and by means of cultures.
The following are the results : —
In the cases of P. M. (No. 7), P. F. (No. 3), T. H. (No. 9), and J. B. (No. 1),
the bacillus of plague was found on microscopic examination, and also cultivated
in a pure condition. In the case of (Mrs. M., No. 5), a few degenerated plague
bacilli were found on microscopic examination, but I did not obtain cultures.
Two days previous to my examination, however. Dr. M'Clure obtained pure
cultures of the plague bacillus; and the negative results obtained by me were
in all probability due to the fact that the disease was in process of cure, and
that the bacilli were dying out. The five patients mentioned have thus been
demonstrated to have suffered from bubonic plague ; and it is of interest to note
that in none of them was any other organism than the plague bacillus obtained
from the glands.
The following were examined with negative results, viz. : — D. T. (No. 6),
Mrs. T. (No. 2), A. D. (No. 14), and J. C. (No. 4). [This does not prove,
however, that these patients had not plague. In fact, the three last-n'xentioned
were recovering at the time of examination; and, if they had plague, the bacilli
would be few, if not entirely gone.]
III. On Tuesday, August 28th, I made a j>ost-mortem examination on the
body of P. M. I found an almost general bubonic affection of the lymphatic
glands, those especially involved being in the right armpit and in the neck. The
glands were greatly swollen and inflamed, partly hjemorrhagic, and partly softened,
while the surrounding tissues were the seat of inflammatory oedema and
haemorrhages. On microscopic examination, these glands were found to contain
enormous numbers of plague bacilli. The spleen was swollen to twice its normal
size. [It is unnecessary to give greater details — a full report has been entered in
the Pathological Records in Belvidere Hospital.] The sum total of the changes
found are met with in no other disease than bubonic plague.
As a summary of the facts above stated, I have to report that, up to the
present date, five patients have been proved by bacteriological methods to have
suffered from bubonic plague, and that one of those (P. M.) died from that disease.
In conclusion, I have much pleasure in acknowledging the valuable collabora-
tion of Dr. M'Clure in the bacteriological work, and the kind assistance which I
have had from Dr. Brownlee and other members of the staff of Belvidere Hospital.
ROBERT MUIR.
Pathological Laboratory,
University of Glasgow,
September 2nd, 1900.
30
THE SIGNIFICANCE OF PHLYCTENULES.
Extract from Report by Frank Tidswell, M.B., D.P.H.(Camb. ), appended to Report ox
THE Outbreak op Plague at Sydney ix 1900, by the Chief Medical Officer of the
Government of New South Wales.
As the outcome of close inquiry into the circumstances attendant upon the well-known liability
to plague infection as a consequence of handling rats dead of the disease, Simond states that a plague
rat is dangerous or not in accordance with the time that has elapsed since it died. If handled soon
after death, plague may follow ; but if not touched for some hours it may then be handled without
risk. It was, says Simond, just as if the infection completely evaporated within a few hours after
death. He also states that perfectly healthy rats harbour very few fleas, and are very expert in
removing them ; but as they become sick they neglect their toilet, and fleas become more and more
abundant upon them, so that they sometimes swarm upon moribund rats. After death, on cessation
of the circulation, and as the body becomes cold, the fleas leave it and seek another host.
By associating the "evaporation'' of the infection with the departure of the fleas, Simond
inferred that these parasites were implicated in the transport of the infection. This inference was
further supported by clinical observations of two kinds, viz. — the site of the bubo and the existence
of a phlyctenule. Simond noticed that persons becoming plague-stricken after handling a dead rat
did not necessarily develop their bubo in the axilla. As often as not in such cases the bubo was
femoral. Hence the infection was not due to direct contact with the rat, but to some associated
circumstance, such as invasion by fleas from the rat. It is obvious that such fleas might inflict a bite
and inoculate the bacilli, not on the hand or the arm, but on the leg or trunk, and thus produce a
bubo elsewhere than in the axilla.
^ * * * * * *
Examinations were made of fleas from healthy human beings, from a plague patient, from mice,
from rats, and from cats. The microscopical examinations all proved negative except in the case of
fleas obtained from a rat actually sick with plague. This rat was taken in a house from which a case
of plague had been removed five days previously, and in the vicinity of wliich many persons were
attacked. The animal was killed with chloroform, and about a dozen apparently stupefied fleas were
obtained from its body. The fleas were crushed up in a few drops of sterilised distilled water, and
as preparations from the emulsion so obtained showed micro-organisms resembling plague bacilli, the
remainder of it was inoculated into a guinea-pig. The animal became sick, and died on the seventh
day. The post-mortem appearances were those of plague, and micro-organisms resembling bacilli
pestis were found in the bubo, in the blood of the heart, in the spleen, and in the liver,
In the experiments performed with living fleas the conditions described by Simond were slightly
modified. A rat, selected because of its having many fleas upon it, was inoculated with plague
bacilli from a culture and placed in a small wire cage. A second healthy rat was placed in a similar
wire cage. The two cages containing the rats were both placed in the same (sheet-iron) larger cage,
the interval between them being about two inches. The inoculated rat died in three days, and its
dead body was allowed to remain in the cage for twenty-four hours. It was then removed, and on
examination was found to be generally infected with plague. The other rat remained perfectly well
for a period of four weeks. The experiment was i-epeated under exactly the same conditions, except
that numerous fleas, obtained by the chance discovery of a mouse's nest, were thrown into the cage,
and upon the inoculated rat. This animal also died in three days, its body left twenty-four hours in
the cage, and when examined found to be generally infected with plague. A third rat was placed in
the uncleaned cage. Neither the first nor the third rat became infected.
It will be seen that the observations we had the opportunity of making in this laboratory gave
support to Simond's assertions as regards the presence of plague bacilli in phlyctenules and in fleas
from plague rats, and, whilst the results in the experiments with living fleas were negative, it has to
be noted, that such tests are obviously liable to miscarry owing to the several uncontrollable fa-ctors
involved in their performance.
PROTECTIVE INOCULATION.
On 1st September a supply of Yersin's serum was obtained, and protective
inoculation of the hospital, reception-house, and sanitary staffs engaged in plague
work was begun. It was also offered to the friends of patients who had been in
contact with them, and to the tenants and others in the neighbourhood of infected
houses. Without exception these latter declined the offer, and only five contacts,
other than those engaged in dealing with the cases, accepted it. Of these five
two developed the disease in an exceedingly mild form (Cases 21 and 26); but it
should be observed that the attacks developing in the four reception-house
inmates (who had no seriim) were also of this character. In all, seventy persons
received injections, the quantity used varying in amount from 10 to 20 c.c. In
addition to this, nine of the patients in hospital were treated with the serum for
31
curative purposes, the dose varying from 40 to 100 c.c.s. Buring the observations
on these latter cases it became apparent that the intravenous use of the serum was
attended with better results where the symptoms could be regarded as due to
plague only, uncomplicated with any other form of coccal infection, than when
injected subcutaneously, but the more careful technique required in this form of
injection is almost unattainable in persons not in hospital. The details of this work
were carried out by Dr. Alfred Webster, and the Table on the following page prepared
by him is of interest because of the careful record it presents of the constitutional and
local symptoms which followed the injections. It was decided to use the serum in
preference to the other prophylactic available, because of the impression that this
latter, in persons already exposed to infection and probably incubating the disease,
might be attended with risk, but there is reason now for thinking that this
impression is erroneous. One of the medical staff was inoculated with Haffkine's
prophylactic.
ABSTRACT OF METEOROLOGICAL OBSERVATIONS TAKEN AT
GLASGOW OBSERVATORY, 1900.
Months.
Tempekatdee.
Rain.
Highest
Temperature
in Sliade.
Lowest
Temperature
in Shade.
Mean
Temperatm'e
for Month,
Departure
from average
of
32 Years.
No. of Days
it fell.
Amount
Collected.
Departure,
32 Years.
January,
51-r
30-2°
39-6°
+ 1-2
25
4-56
+ 0-88
February,
50-0°
14-8°
34-0°
-5-2
14
2-86
-0-20
March,
52-7°
26-2°
37-8°
- 2-4
8
0-43
- 2-06
April, ...
66-9°
32-7°
45-6°
+ 0-9
18
2-04
+ 0-06
May,
69-5°
35-7°
49-9'
+ 0-5
17
2-16
-0-32
June, ...
74-0°
43-9°
56-3"
+ 1-1
17
4-34
+ 1-59
July,
73-9°
46-3°
58-7'
+ 1-2
23
3-54
+ 0-41
August,
77.70
45-8'
56-0°
-0-8
17
4-91
+ 1-08
September,
68-2''
39-2°
53-5°
+ 0-6 1
17
3-38
-0-30
October,
60-r
31-3°
46-3°
-0-4
20
5-44
+ 1-78
November,
57-8°
27-0°
43-2*
+ 1-2
21
5-86
+ 2-11
December,
55-0°
34-3°
44-2°
1
+ 5-7
29
7-34
+ 3-38
32
Phrophylatic Use of Yersin's Serum — Dosage and Results.
1900.
Name nnd Status.
Quantity.
Length of
Exposure.
Constitutional untl Local Sj mptoms.
September 1,
1,
3,
3,
3,
2,
October
3,
3,
3,
3,
3,
3,
3,
5,
5,
5,
5,
5,
7,
7,
7,
7,
7,
7,
7,
7,
7,
9,
9,
10,
10,
10,
10,
10,
10,
4,
10,
10,
10,
10,
10,
10,
14,
14,
14,
14,
14,
15,
15,
15,
16,
16,
20,
20,
21,
25,
25,
25,
29,
1,
1,
1,
1,
1,
1,
1,
Dr.,
Dr.,
Dr.,
Dr., - - -
Dr.,
Dr., - - -
Dr..
Nurse,
Nurse,
Nurse,
Nurse,
Nurse,
Ward Maid, -
Van Driver,
Nurse,
Nurse,
Nurse,
Nurse,
Nurse,
Dr.,
Dr.,
Bact. Laby. Assistant,
Inspector,
Dr.,"
Dr., - - -
Dr.,
"W'ashing-house Staff,
Mrs., 27 Warwick Street,
Dr., ....
Van Driver,
Collector.
Washing-house Staff,
J. T., .
Mrs., 52 Dale Street,
J.,
Mrs., ,,
M'L,
Mrs., ,,
Mrs., 23 Florence Street,
Keception-liouse Staff,
Ward Maid, -
>^ '
Nurse, - . . .
Nurse, - - . .
Dr., . . . .
W., 57 S. Coburg Street,
C,
J., 52 Dale Street, -
G.,
Dr., . . - .
Dr., . . . .
Dr., . . . .
Dr., . . . .
Dr., - •
D., Belvidere,
D.,
M'M.,
M.,
M'C,
K.,
S.,
10 c.c.
20 c.c.
10 CO.
20 c.c.
15 CO.*
15 c.c*
20 cc
10 cc
20 cc.
Dayv.
9
9
9
No contact.
7
No contact.
No contact.
2
15
14
14
14
14
14
14
15
2
• >
2
2
2
21
No contact.
22
September 14.
No contact.
8
13
30
30
No contact.
Erythema and urticaria, 7th day.
Urtiicaria, 7th; acute arthritis, 11th.
Urticaria, 10th to 12th ; marked fascial and articu-
lar pain, 2nd to 3rd week ; general malaise.
Erj'thema, oth day ; urticaria, 7th day.
Erythema urticaria. 8th day.
Erytliema urticaria, 7tli day.
Urticaria, 8th day.
Erythema urticaria, 1st week ; joint pains, 2nd
week.
Erythema, 3rd day ; urticaria, 4th day.
Erythema, 5th day ; urticaria, Sth day ; joint
pains, Sth day.
Sickened on Sept.- 13 with symptoms of plague,
enlargement of cervical glands.
Erythema urticaria, 1st week.
,, ,, 5th day.
,, ,, 10th day ; joint pains, 11th
to 15th day.
Erythema virticaria, joint pains, 4th day.
Erythema.
Erythema urticaria, 1st week.
Erythema, 9th ; urticaria and joint pains, 10th.
Erythema urticaria, Sth day.
,, ,, 7th day.
Erythema urticaria, 8 to 10 days.
,, ,, 7 to 9 days.
Malaise at end of 1st week.
Enlargement of axillary gland.
Erythema and urticaria, Sth day.
Developed plague on September 18.
Erythema on 6th day.
Erythema, 2nd day ; joint pains, 10th day.
Erythema and urticaria, 7th day ; acute joint
pains, 14th day.
Acute general joint pains, 10th day.
Local erythema and urticaria.
Urticaria, Sth day ; joint pains, 4th day.
Erythema and cedema of the arm around
puncture on 2nd day.
Erythema and urticaria on 11th day ; cedema of
legs and ankle, 12th day ; acute joint pains in
hip, knee, and ankles, with general malaise.
Contacts in the ward, Belvidere.
* Second injection.
APPENDIX.
INTERIM REPORT BY MEDICAL OFFICER OF HEALTH, SUBMITTED
TO HEALTH COMMITTEE ON 10th SEPTEMBER, 1900.
At last fortnightly meeting of the Committee I reported that a careful study of the symptoms
presented by three patients then in hospital gave rise to the conviction that they were suffering from
plague. This conviction was ultimately established beyond doubt, and the following narrative
describes the circumstances of the outbreak so far as at present known.
* * * * * * * * * #
(See page 22. )
Immediately the suspicion of plague was created, a medical examination was made of all persons
who could be discovered as having attended either the B. wake or the wake of the child M. , with
the following results : —
1. Discovered ill in their own houses —
(1) Two children (T.), sons of Mrs. T. already referred to. One of tliese, on closer
observation, proved not to be plague,
(2) A girl (M'K.), residing at 57 Thistle Street.
2. Removed to reception-house.
In all, over 100 persons, who were not obviously ill, but had visited one or other of the houses named,
were removed to the reception-houses for observation, and four of tliem have since sickened (M.,
M'G., D., and R.) (For dates see Table which follows.)
Two additional cases, F., 77 Rose Street (admitted 29th August), and C, 1 Well Street, Calton
(admitted 30th August), were afterwards brought under notice by medical practitioners, suffering
from the disease, and, after examination, removed to hospital. C. has an indirect connection, in
respect of having slept in a house next door to that of the B. family on 15th August, and F. is a
jobbing shoemaker living in the adjoining tenement.
On 6th September, one of the "contacts" under observation displayed symptoms of tenderness
in the groin, and was removed to hospital for observation. Phlebitis of the femoral vein there
developed and cleared up the suspicion. On the following day a child was removed from Crookston
Street with symptoms suggestive of pestis minor, and a history of indirect association with one of
the wake-contacts. In 8 of these cases the diagnosis of plague has been microscopically verified.
From the following Table, a family (U.), from 57 Thistle Street, is presently omitted, because of
some uncertainty regarding the clinical importance to be attached to their symptoms : —
GLASGOW.— PLAGUE CASES, WITH DATES OF SICKENING AND EXPOSURE AS
PRESENTLY KNOWN.
Deaths at Home [assumed to be due to Plague).
Name.
Address.
Sickened.
Died.
Wake lield.
(1) Baby in B. Family,
(2) Mrs. B.,
(3) Tina M.,i
71 Rose Street,
57 Thistle Street,
Aug. 3rd,
3rd,
,, 19th,
Aug. 7th,
„ 9th,
„ 21st,
Aug. 9th and 10th.
„ 21st and 22nd.
1 Attended the B. wake.
Cases Removed from their Homes.
Name.
Age.
Address.
B. (1) James B.,
B. (2) Pat. F.,
60
56
71 Rose Street,
77
B. (3) John C,
24
1 Well St., Calton,
B. (4) Mrs. T.,
(5) James T.,^
(6) Dennis T.,
9
6
23 Oxford Lane,
) ?
B. (7) Mrs. M.,
B. (8) Pat. M.
(9) Wm. M.,
3
57 Thistle Street,
))
(10) Annie M'K..
12
B. (11) Thomas H.,
12
6 So. Coburg St.,
Sickened.
Aug.
Removed to
Hospital.
12th,
13th,
Aug. 27th,
,, 29th,
17th,
,, 30th,
12th,
21st,
21st,
„• 25th,
,, 29th,
,, 29th,
20th,
22nd,
23rd,
, , 2oth,
,, 25th,
,, 25 th,
28th,
,, 29th,
23rd,
,, 29tli,
Where Exposed, <fec.
Wife died 9th August.
A jobbing shoemaker near
B.'s, but definite contact
not traced.
Slept in house adjoining
B.'s on 13th August.
Relations and visitors at
B.'s.
(Attended B.'s wake, child
died at liome on 21st
August (see above). Pat.
M. died in hospital.
At B.'s wake, and after-
wards in house.
At M.'s on 20th Ausuyt.
B. = Bacillus obtained.
2 James has not plague, but a gluteal abscess.
34
Cases among "Contacts" and Sickening in Reception-house.
Name.
Age.
Address.
Sickened.
Removed
to Hospital.
AVliere Exposed, &c.
(12) Jane M.,
(13) Arch. D.,
(14) Patrick M'G.,
(15) Agnes R.,
14
18
Aug. 29th,
,, 29th.
„ 31st,
,, 31st,
At M.'s wake.
) 1
) 3
Indirect Contact.
(16) May M'L.,
18
months.
154 Crookston Street,
Aug. 26th,
Sept. 6th,
Indirect contact (?)
Note. — This Table does not include a family (D.) removed from 57 Thistle Street on August
At the present moment it is impossible to make any definite statement as to the source of the
infection of the first two cases in the B. family. The husband of the elder patient was in the service
of a local shipping company as a dock labourer, and employed by them at their wharves on the south
side of the river. He was engaged exclusively on vessels trading between home ports. His illness
only developed after his wife died, and may be regarded as resulting from this or from his grandchild's
illness. His daughter, the mother of the child who first died, is said by her father to have been ill
for two days shortly before her child sickened. She now displaySj one month afterwards, very slight
enlargement of the cervical and axillary glands on both sides, which, compared with the glands of a
normal girl — definitely non-infected — of corresponding age, indicate some irritative process recently
active. This girl, meanwhile, stoutly denies any illness, and it must be remembered that she had
nursed her baby for some time. The father of the child is an iron-worker in constant employment.
He has had no illness, and presents no evidence of glandular enlargement.
[Note. — Since the above was written one case, clinically recoguisable as plague, and verified by
bacteriological examination, was admitted to hospital on Sunday, 9th current, and a girl, whose
illness goes back to the 28rd of August, was removed the following day. These are not traceably
connected with each other, or with any of the earlier wakes, and, taken in connection with the death
in Govan during the last week of August, must be regarded as indicating that a strain of infection,
has obtained admission to the population from which each of these four groupings directly arise.
The means by which this strain of infection has gained access is presently conjectural only ; but
it is to be remembered that pestis minor, or the ami)ulant form of plague, is a disease characterised
by few symptoms, and must frequently escape detection. In this connection the occurrence of several
cases of sickness, with glandular affection, among the crew of a ship while in port here in May last,
is being inquired into. Any opinion as to the character of an illness described after such an interval
can only be formed after very carefid scrutiny of the facts ; but it is obviously most desirable, in the
interests both of the shipping and the community, that all such sicknesses, when they occur, should
be promptly brought to the notice of the Local Authority.]
* ■)(■ * * * « -x- * -if *
(See p. 22.)
SECOND INTERIM REPORT BY MEDICAL OFFICER OF HEALTH,
SUBMITTED TO THE HEALTH COMMITTEE ON 24th SEPTEMBER, 1900.
Since 19th September no case of plague is known to have occurred among our own population,
the admission to hospital on the 20th being that of a male patient from Govan, who had been sent to
one of the general hospitals for treatment for wh;it was regarded as a surgical affection, aud was from
thence transferred to Belvidere.
The following table continues the record of admissions since those contained in the report for last
fortnight : —
Name.
Address.
Date of
Sickening.
Removed
to Hospital.
(1) Chas. M'M.,
52 Dale Street,
Sept. 8th,
Sept. 9th,
(2) RosinaM.,
23 Florence Street,
Aug. 23rd,
,, 10th,
(3) Mrs. B. ,
81 Cubie Street,
Sept. 13th,
„ 14tli,
(4) Ellen R.,
(5) George H.,
(6) Mrs. M.,
Belvidere Hospital, •
248 Mathieson Street,
57 South Goburg Street,
,, 13th,
Vth,
,, 14th,
„ 14th,
, , 14th,
,, 15th,
(7) Mary M.,
(8) Robert M.,
(9) Mrs. M.,
(10) Mrs. G.,
(11) Mary G.,
(12) Wm. W..1
52 Dale Street,
21 Robert Street, Govan,
,, 14th,
,, 14th,
,, 13th,
,, 18th,
,, 18th,
,, 1st,
., 15th,
,, 16th,
., 16th,
19th,
,, 19th,
,, 20th,
Where Exposed.
Slept on a bed on which a
neighbour had died from
"pneumonia" on 2Sth
August, and was buried
1st September.
Worker in a hair factory,
but with no known
association with other
cases.
Wife of a clothes collector
in Sanitary Wash-house.
Cleaner in Plague-ward.
See Note in text.
A married daughter of the
other Mrs. ,M. admitted
16th September.
See details in text.
Sister and niece of C. M'M,
above. See note below.
' Admitted through one of General Hospitals.
35
In addition to the above, five persons were removed to hospital during the fortnight presenting
symptoms wliich at the time gave rise to a suggestion of plague. In four of these the further
development of symptoms enabled them to be set aside definitely as not plague, vv^hile one case still
remains under observation.
Relationship op Cases. •
(1) C. M'M. has no relation which can be traced with earlier known cases. A neighbour had
died on 28th August of " pneumonia," and was buried on 1st September. After the death the bed on
which he had lain was transferred to M'M.'s house, and was used by M'M. and his wife.
(10) Mrs. G. is a sister of this patient, and sickened under observation on 18th September. On
lOtli September she had been given subcutaneously 10 c.c. Yersin's serum. A mild attack.
(10) Mary G. , aged six years, a daughter of last patient, also sickened on 18th September.
Because of her age and some passing indisposition an injection of Yersin's serum was not given. Her
attack has proved fatal,
(2) Rosina M. sickened 23rd August, a swelling in the groin being observed by herself on 26th.
She had no regular medical attendance, and the nature of her illness was not recognised till 10th
September.
(3) Mrs. B., the wife of an employee of the department engaged in the work of collecting infected
clothing. He must therefore be regarded as the transmitter of the infection to his wife, and for this
reason the occurrence will require the most rigid investigation. For several years it has been under-
stood that the collectors were provided with overalls to protect their clothing, and to be worn only
when at work. It now appears thafwhat they wear is not an overall suit, but simply clothing of a
white material. His wife now makes the definite statement in hospital that he regularly came home
in this suit, and occasionally wore a coat to render it less conspicuous. For the present I have
recommended that after each remnval of plague clothing the collector must bathe and change his
entire clothing before leaving the wash-house.
(4) Ellen R., a ward cleaner, employed in the plague-ward, and, like all tlie others whose work
brings them into contact with these cases, she received an injection of 10 c.c. Yersin's serum. This
was on 3rd September, and she sickened on 12th, her illness being of the mildest possible description.
The micro-organism has, however, been recovered from an affected gland.
(5) George H., 46 years, boot-top fitter, residing at 248 Matliieson Street, was admitted to
hospital on 12th instant, and died on the following daj'. Examined post ■mortem, this was found to
have resulted from plague. He sickened on 8th September. His illness was associated with earlier
illnesses in a family (G.) living at the same address. Mrs. G. was removed to hospital on 1st instant,
and died on the 4th of suspected typhus, whilst her daughter, at the time of her removal, was
discovered dead in their house. In Mrs. G.'s case the question of plague was considered, because
she was known to have been a visitor at tlie family B. when the earlier cases occurred ; but the
diagnosis held in suspense. On pont-moriem examination the evidence was still held as inconclusive.
(6-9) M. Family. — A mother and three children, one of whom was married, formed one house-
hold, in which, we were informed by neighbours, cases of illness were occurring. They have an
indirect association, through a "contact," who visited them frequently, with the family T., of 23
Oxford Lane, and on 22nd August a daughter of the family, named Kate, aged 14 years, sickened,
and died on the 28th August, the cause of death being certified as "pneumonia." Tlie friends now
describe her illness as having been accompanied by painful swellings about the neck and arms.
Putting together the admissions since the disease was recognised, we have now had a total of
27 admissions from definitely recognisable plague, and of these, up to the present (26th September), 5
have died and 22 remain under treatment, 1 of these being a patient from the adjoining burgh.
Mild Nature of Attack in Many Cases.
Eight only of the cases coming under treatment in hospital can be classed as severe attacks, and
of these 5 have died. Seven, on the other hand, are of extreme mildness, so that, save for their
association with recognisable cases, a suggestion of plague would never have been raised.
Twelve fall into a middle class, the severity in individual cases ranging between the severe and
mild type just alluded to, but with a tendency to mildness rather than otherwise. Indeed, with
regard to many of the milder forms, the question of diagnosis is no easy one. V/e are familiar in
smallpox outlireaks with the extremely modified form which the disease may present in persons fairly
well protected by vaccination, and where a definite history of exposure alone affords a means of
interpreting aright symptoms which would, indeed, rarely be critically surveyed were the persons not
under observation at the time.
We are now learning practically that in a correspoading way plague can become so defaced by
mildness in its form of attack that an administrative difficulty of no inconsiderable magnitude is
created. Consequently, I believe safety lies in disregarding the query which constantly haunts those
milder forms, and dealing with the surroundings and associates of the suspect as if no doubt as to its
nature existed.
Yersin's Serum.
Over 60 persons known to have been in association with plague patients have been immunised by
subcutaneous injection of Yersin's serum in 10 c.c. doses. Of these, 2 have sickened of a very
modified form of the disease.
36
Questions of dosage and the method of administration will require consideration in the light of
the partial failures. The serum is much more powerful as a curative agent when injected into the
veins than when given subcutaneously, and it may be that the full protective value for " contacts"
is only to be obtained by a similar selection of site.
Return of Contacts to the General Population.
A not unnatural degree of apprehensiveness exists regarding these people on their discharge
from the reception-houses. It may serve to allay this if it is explained that when they are passed
out of observation by the department they are themselves free from any risk of developing the disease
to which their contact with plague patients had exposed them, their clothing has been disinfected,
and there remains nothing about them save the memory of their association.
(See page 23.)
Notices under Glasgow Police Act, 1866, Section 254.
The following Notices under this section have been issued : —
Week ending 8th September.
Dirty Stairs, Lobbies,
Dirty Houses. and Passages. Total.
35 42 77
}Veek rnding loth September.
Dirty Stairs, Lobbies,
Dirty Houses. and Passages. Total.
176 79 255
Week ending 2i2nd September.
Dirty Stairs, Lobbies,
Dirty Houses. and Passages. Total.
244 14 258
The number of cases of overcrowding discovered in the defined area is as follows ;
Week ending 8th September,
Week ending 15th September,
Week ending 22nd September,
Sanitary Chambers,
Glasgow, 24th September, 1900.
38 cases.
27 cases.
29 cases.
A. K. CHALMERS.
THIRD INTERIM REPORT BY MEDICAL OFFICER OF HEALTH,
SUBMITTED TO THE HEALTH COMMITTEE ON 8th OCTOBER.
During the fortnight the following deaths from plague occurred in hospital : —
Name. Date of Death. Date of Admission. Reference No.
James B., ... September 24th, ... August 27th, ... No. 1 of 1st Interim Report.
MaryG., ... September 25tli, ... September 19th, ... No. 1 1 of 2nd Interim Report.
iBabyM., ... September 27th,
Robert M., ... September 28th, ... September 16th, ... No. 8 of 2nd Interim Report.
William W., ... October 6th, ... September 20th, ... No. 12 of 2nd Interim Report.
• Tliis child was born in hospital of Mrs. M. (No. 6 of 2nd Interim Report) on 16th September, and died on 27th,
having been ill for three days. From birth it was a delicate child.
No case is known to have occurred among the population during the fortnight, but among persons
brought under examination the following may be selected as illustrations of illnesses which at one
part of their course at least present symptoms suggestive of plague, and require careful scrutiny
before exclusion : —
(1) J. M'C. (male adult), sickened on 27th September with shivering and headache, which were
followed on the 28th by pain in the right axilla. On examination on October 2nd and 3rd, there was
a general thickening in this situation, which was tender on pressure, although definite glandular
enlargement in the axilla could not be discovered. In the left axilla, however, several glands were
palpable, but were not tender on pressure. He was removed to hospital for observation, and in the
course of the following day an abscess of a distinctly septic character appeared in the right axilla.
(2) Mary M'F. , aged 13, was admitted to hospital on Saturday, 6th October, with the following
history : —
"About twelve days previously a swelling appeared in the right groin, which, on examination,
was not painful to pressure, and had not given rise to constitutional disturbance." Further examina-
tion of this gland has quite definitely excluded plague.
37
(3) On 6th October, a boy, M'E. , was notified as suffering from " fiever, probably typhus," and
on the house being visited it was learned that he had died on the previous evening. A history of
illness beginning suddenly in the midst of apparently perfect health, and accompanied by vomiting
and high fever, with rapidly increasing prostration, followed by death within twenty-four hours,
aroused suspicion, which was strengthened by an external examination of the body and the discovery
of a chain of enlarged cervical glands on both sides of the neck and in the left axilla. The body was,
in consequence, removed to the mortuary at Belvidere, and, with the father's consent, a post-mortem
examination was there made by Dr. Buchanan. This revealed a tonsillar abscess, with a widely
distribiited glandular enlargement, all pointing to an extreme degree of susceptibility to septic
poisoning, to whicli the death can be attributed. Evidence of plague was entirely absent.^
Professor Zabolotny, of the Imperial Institute of Experimental Medicine, St. Petersburg, who in
recent years was a member of the Russian Expedition for the Studj' of Plague in India, Arabia, and
Eastern Mongolia, and who spent several weeks here on behalf of his Government, left Glasgow on
Saturday last, and was good enough to convey to me his conclusions regarding the outbreak here.
As these will be of interest to the Committee, I reproduce them : —
(1) The epidemic in (dasgow, when compared with that of India, China, and Africa, and with
those in Europe of recent years (Oporto, Kolobowka), is of the most mild description.
(2) The extension of the epidemic is not great, and the mortality quite insignificant, which may
be attributed to the medical and sanitary measures which have been here practised with so great
energy.
(3) For the most part one meets with bubonic cases which are less dangerous from the point of
view of epidemiology than the pneumonic forms. These latter are excessively contagious, because
the sputum of the sick person teems with plague bacilli.
(4) As in the bubonic form, the sickness does not spread except by contact with the skin, the
measures of isolation and cleansing of linen and clothing play a most important role in prevention.
(5) For persons in contact with the sick the best method of protecting them is by preventive
injection with serum (10 to 20 c.c. ), as is here practised.
(6) Treatment of the patients is most effective when the serum is injected in large doses (60 to
120 c.c.) intravenously.
(7) The post-mortem examinations of fatal cases have presented a picture of protracted illness
(suppuration, nodules pestewt, mixed infection), and not that of an acute malady terminating fatally
in from two to three days.
Notices under Glasgow Police Act, 1866, Section 254.
The following notices under this section have been issued : —
Week ending 29th September. Week ending 6tli October. Grand Totals.
Apartments. Apartments. Apartments.
2. 3. 4. Total.
1. 2.
3.
4. Total.
1. 2.
3.
4.
Total.
37 106 18 1 162
35 75
25
4 139
72 181
43
5
301
The number of cases of overcrowding discovered
in the defined
area is as
follows
Division.
Overcrowded.
Fined.
Admonished.
19
54
3
19
20
25
7
21
28
10
14
22
6
4
3
113
17
43
PLAGUE IN GLASGOW IN THE 17th CENTURY.
An Extract from Memorials of the Faculty of Physicians and Surgeons of Glasgow, by
Alexander Duncan, M.A., LL.D., Secretary and Librarian of the Faculty.
But the most memorable epidemic of the plague was that which visited Glasgow in 1645-46, and
during that, and perhaps the next two or three years, made terrible havoc amongst the townsmen.
Almost from the first the most determined efforts were made to stamp out the disease. Daily house-
to-house visitation was eventually adopted, and daily reports sent to the magistrates of the sick.^
When the measure to arrest its progress failed, it was resolved to have recourse to the old expedient
of transporting the infected out of the town to the muir. This muir is believed to have comprised
the waste-lands of Sighthill, Seggiehobn, and others in the district to the north of the burgh.
Intimation was to be made " be touk of drum that na manner of persone goe out to the muir quher
the foull persones are without leave of the magistratis, and to certify that those who on the
contraire schall be put out to the muir with the haill families they are in."
' See Dr. Buclianan, p. 85.
2 Minute of Council, 6th November, 164G.
38
The prevailing terror invaded the academic precincts in High Street, the University authorities
migrating in a body to Irvine, where tlie princinal, the regents, and the bursars of the College were
boarded in 1645 and part of 1646. Local trade was almo5t at a standstill. Nearly all who could
leave the town appear to have done so. The burgh tollmen and tacksmen had to beg off from the
payments of their rents. " Gomperit the haill takismen of the mylne, Laidells, tron, and brig, and
intimat to the Oouncell that in respect of the seikness and visitatioutie they could get naething of
ther deuties." The buiial of the dead was unaccompanied by the usual rites. On 12th December,
1646, it was ordained "that ther be na melting at lykwakes nor efter burrialls, and that this be
intimat by touk of drume."'
If such was the state of things in the burgh, who can imagine the horrors of the plague-stricken
banished to the bleak muir? The time was the depth of winter, their only shelter was " ludges
made of daills and spairs," with straw for their bedding. By 20th February, 1647, the visitation
of this miserable colony had assumed a sj^stematic form. "James Robiesoune, baxter, is maid
choyce of to be visitour of the muire quhair the oncleane fokes ar, and to set doune in a register all
occurantes daylie anent the iufectioune, . . . and to tak notice of the graves. '' P'roquent entries
also appear in the treasurer's accounts at this time ^ of disbursements for supply of the poor on the
muir, and for "coals, peitts, and strae" furnished to them. On 17th July the Councillors are
appointed by turns for a week to visit the muir, each selecting "an other honest man," to receive
a list of all in the muir, and to "disburse to James Robiesoune such money as he sail requyre to
sustean the puire on the muir, and to viseic the muir tweiss or thryiss in the week," with other
necessary duties of a similar kind. Doctor Rae, possibly a physician reputed to have skill in the
treatment of the plague, is written for, but apparently does not come, and Dr. M'Cluir is engaged,
and on 26th July got ten dollars " for bygane service to incouradge him." From a subsequent
minute it appears that John Hall, the principal surgeon in Glasgow at that period, by arrangement
with the magistrates, gave his services to all and sundry gratuitously, being subsequently paid by
them as well for inspecting the bodies of the dead as for his care of the living. -
Within the burgh it would appear that sanitary measures were prosecuted with energy. There
is a curious minute of 10th March, 1647, in which the bailies, with the a,id of a hired man, are
charged with the duty of removing "suspect fulyie." In these days the honourable office of the
magistracy was clearly very far from a sinecure. One noteworthy result of the compulsory removal
of such large numbers of the citizens to the muir was that the magistrates found that they were
obliged pro te'iipore to make payment of their plague patient's dobts.^ From some subsequent
minutes we infer that some amount of imposition had been practised by the " unclean " or their
friends. Thus, on 13th March, we find two men appointed to revise " the compts debursit fur honest
men the tyine they closit up for fear of infectioune." Through the whole of the summer and autumn
of 1647 the plague appears to have been raging with virulence. As the College session drew near,
it was necessar3' to make some arrangement in regard to a temporary local habitation till the plague
abated. Irvine had probabl\- Keen foun.i inconvenient on a -count of its distance from the city.
Paisley was now selected for the purpose, being clear of the pest, though its past reputation as a
plague-haunt was not good, and there the College authorities spent part of the winter.''
On 22iid July, 1648, the pestilence was still on the increase ; a daily inspection of everybody in
town was again arranged for, and a proclamation made by tuck of drum prohibiting the frequenting
of taverns, or even idle wandering through the streets. From the Town Cuuncil Records (for 12ch
August, 1648) we learn that (ilasgow was now in sore straits for money for the maintenance of such
numbers of the stricken poor. Accordingly they agreed to call in a sum of two thousand marks,
collected, but not expended, some years before for a similar purpose, and now on loan to the Earl
of Vv'igtowia. It was not till the following year that this terrible visitation of plague appears to
have come to an end in Glasgow.
In 1665. when the dreadful scourge made its memorable inroad on London, and more than
decimated the population, the Town Council Records (3rd September) show that the people of
Glasgow were alarmed and on the watch. In the previous year even they were evidently on the
alert, the Master of Works having been ordered to repair the ports. This was always done when
they had reason to fear an outbreak, as if the magistrates hoped to repel the impalpable infection
of what, with emphatic tautology, they call "the plague of pestilence " from their gates by the
same measures as they would the attack of an armed foe. The dreaded visitor, however, did not
make its appearance in Glasgow then or subsequently. Its sudden disappearance not long after,
not only from this country, but from Western Europe generally, has often been made the subject
of remark, though scarcely explained.^
1 Minute, 29tli May, 1647, &c.
- Minutes of 18th September, lfil7, and 26th August and 2nd October, 1648.
3 Minute, 20th February, 1647.
* Macltle's History of Paisley, p. 143. See also Muniinenta Universitatis Glasguensis, III., p. 537.
\The cause of its sudden decline and extinction are discussed by Creighton (History of Epidemics in Britain,
II., 34 el. seg.)
39
NOTES REGARDING SYMPTOMATOLOGY.
By John Brownlee, M.A., M.D.(Glas.), D.P.H.(Camb.), Physician-
Superintendent, Belvidere Fever Hospital.
The following remarks summarise briefly the chief symiDtoms which were observed
in the cases of plague seen in Belvidere. No attempt has been made to dissert on
the symptoms of plague in general, but only to give, as far as possible, an accurate
summary of what was actually observed.
Onset of the Disease. — The onset of the disease was, in general, severe, but did
not differ markedly in any respect from that of other specific infectious
disease. In only one case were there any prodromal symptoms. In this case
slight headache and malaise seem to have been present for three days prior to the
true onset of illness. The onset was, in general, associated with severe headache,
and often with rigor. Severe prostration, and pain in the back and limbs, were
also marked features. Vomiting, though not frequent, was sometimes a very
urgent symptom, and in one case lasted through the whole of the first week of
illness. Although constipation was more often observed than diarrhoea, yet
the latter was jjresent with sufficient frequency to negative the diagnostic value
of either symptom.
Fades. — Even at an early stage of the disease the fades was very characteristic.
The face assumed an earthy pallor, which was more marked round the lips. The
expression was dull and heavy, resembling that seen in tyjihus, to which was
superadded a look of anxiety, which was most noticeable and striking. If the
patient was handled, even with the greatest care, the brows contracted, and the
face assumed a more marked appearance of apprehension, which was further
exaggerated if the area surrounding the bubo was touched. This was very
noticeable even in patients who were on admission quite unconscious to all outside
impressions. The characteristic fades was also observed, though to a less extent,
in nearly all the cases of pestis amhulams.
Course of the Temperature. — With the onset of the disease the temperature
seems at once to have risen. In the cases which came under observation on the
second day of illness, with one exception, the height of the fever had by that time
been reached. In severe cases a high and somewhat irregular jjyrexia, ranging
from 102° F. to 105° F., was present, usually remittent, the morning temperature
being from one to two degrees lower than that of the preceding evening. In
general, the pyrexial period ended by crisis or rapid lysis. This occurred even in
cases which ultimately terminated flitally from secondary sepsis. The crisis took
place between five and eighteen days from the beginning of the illness in the
untreated cases. In the milder cases an early fall to nearly normal, with a
secondary recrudescence, was not unusual. In those in which secondary infection
was present from the beginning, the temperature resembled that of an ordinary
septicasmia. In the very severe cases, with rapid death, it remained continuously
high until the fatal issue.
In the cases treated with serum, the course was often apparently modified,
as will be found specially recorded in another section.
Bilboes. — -The chief sign of plague, as seen, was the bubo. All the cases
treated in hospital, with one exception, which will be discussed separately,
were of the bubonic type. The character of the bubo varied, of course,
with the severity of the case. In its simplest form it consisted of an enlarged
lymphatic gland, with some infiltration surrounding it. The skin above it might
be freely moveable. Even in this, the simplest form^ the tenderness of the
swelling was a feature which was so marked as to attract immediate attention to
its presence. The limitation of the bubonic infection to one gland was, however,
very unusual. In most cases the groups of lymph glands which fill the axilla or
the groin were concurrently affected. In severe cases the implication extended
further, and the involvement of adjacent groups of lymphatic glands took place.
40
In these instances, though the surrounding connective tissue was markedly infil-
trated, yet the separate glands could, in general, be felt on palpation, if a little care
were exercised. This was, of course, much more noticeable in the groin than in
the axilla. Over the affected glands the skin was usually reddened. The colour
at first was rose, turning afterwards to a deeper red, and finally to a dusky purple
colour.
As the bubo advanced there was frequently an exudation of serum into
the neighbouring connective tissue. This was often slight, but in some cases
there was a widespread oedema into the area of which the bubo was the central
point. In one case this oedema extended from the middle of the abdomen to the
foot. In one other case, with bubo in' the groin, although the oedema surround-
ing the bubo was slight, yet marked swelling of the foot on the affected side
was observed.
The life-history of the bubo was various. In the slighter cases resolution
took place without breach of the skin-surface, but in the majority of cases the
bubo ruptured spontaneously, and discharged for a time before healing. The
discharge was sero-purluent, flakes of pus appearing suspended in a slightly-turbid
serous fluid. Microscopical examination of this fluid showed degenerate bacilli,
both free and included in the leucocytes. Cultures made from the discharge were
generally sterile, if due precautions in cleansing the skin were observed ; at most,
a few colonies of skin-cocci were obtained. In only one instance was the B. pestis
in a virulent condition recovered from a bubo which had spontaneously ruptured.
In the severe cases extensive necrosis of the glands occurred, involving, also, large
areas of skin, and in such cases it was impossible to prevent secondary infection.
If this occurred, two results were noticed. If the area of necrosis were small, the
process remained localised ; while if the area of necrosis were extensive — as in the
case of J. B. — a widespread extension of the secondary infection occurred, and
death resulted from septicaemia. It is worthy of note that the discharge from
the ruptured buboes was always sero-purulent. Even in slight illnesses it was
moderately abundant, and only slightly mixed with pus cells. It seemed, in fact,
to consist largely of the normal lymphatic drain into the affected glands. It was,
in the case last referred to, very abundant indeed, the dressings being very
frequently soaked, and requiring to be renewed. In a number of the cured cases
the discharge continued for some weeks, and in one case there remained for a
longer time a small lymphatic fistula discharging clear fluid.
The tenderness of the buboes was a feature of great interest. In only one
case was this symptom absent. In some patients the pain on touching was so
great that even the movement of the bedclothes produced considerable distress. It
is also worthy of note that this tenderness disappeared almost completely with
the fall of temperature, and although the swelling was some time longer in
showing any signs of subsiding.
SJcin. — The skin in all cases of plague observed was dry and hot. Sweating,
even during a crisis, was not a constant symptom — in fact, the only two cases in
which it was noted were those in which doses of Yersin's curative serum were
administered. (Cases Nos. 9 and 19.) Otherwise it was only noted in those
patients who suffered from secondary septic infections.
There was no specific rash observed, but over the trunk and thighs, in a certain
number of the severer cases, a mottling of a pronounced character was noted.
This mottling was more marked than the subcuticular mottling of t_yphus, but not
so noticeable as the commencing mulberry eruption. This naottling disappeared as
the disease progressed, and gave place to a general dusky hue of the whole cuticle.
Petechige, or hsemorrhage, were not observed in any of the cases which were
admitted to hospital.
Desquamation of the cuticle was not infrequent. It began towards the end of
the second week in a punctiform manner over the trunk and limbs, and in some cases
on the palms and soles the separation of the cuticle was complete, as in scarlet fever,
41
the jjatches separating being tough and not friable, differing in this resj^ect from
the desquamation which often accompanies continued fevers, such as enteric.
Alimentary Tract. — The lips in the severe cases were dry and cracked, and
occasionally covered with sordes; in the milder cases they presented nothing
noteworthy.
The tongue was covered with a white fur, and was usually clean round the edges.
Even in severe cases it was often not dry. In the worst cases, however, as the
disease progressed, it became dry over the dorsum, and covered with a brown fur.
Even in these cases, however, the edges usually remained moist.
The fauces were, as in most fevers, somewhat congested, but presented nothing
noteworthy.
Vomiting was not a common but sometimes an urgent symptom at the onset.
The bowels were in general constipated, but sometimes the attack was ushered
in by severe diarrhoea.
The plague patients, as a rule, fed well during the attack.
Heart and Circulatory Organs. — In the acute cases the heart sounds were
soft, but murmurs were absent. The pulse was at the onset full and bounding,
but rapidly became soft and easily compressible. The rate varied very much, but
in general it was lower than that usually seen in other fevers with a corresponding
temperature. In the severest type of case, however, the rate frequently evidenced
a very profound degree of cardiac poisoning (e.g., a temperature of 105'8°, with a
pulse of 134, in an adult, and a temperature of 103'4°, with a pulse rate of 152, in
a child of six years.)
In general the fatal issue was accompanied by the usual quickening of the
pulse, which is the symptom of cardiac failure.
Respiratory Organs. — The respiration rate in plague cases was, as a rule,
strikingly increased, as compared with that usually observed in other cases of
fever, apart from any increase in pulse rate. The normal pulse-respiration ratio
of 1 to 4 was almost invariably often much disturbed without any lesion being
discoverable in the lungs. Sometimes a few subcrepitant rales were present at the
base of the lungs.
Pneumonia was present in a number of cases as a complication, and in these
the signs present were those indicating that the lesion was patchy and not lobar.
Hypostatic pneumonia was present in a certain number of the fatal cases much as
it is in any other continued fever. As a sequel of the disease, pleurisy, without
effusion, was observed in one case.
Spleen. — The spleen was in some cases enlarged, but not markedly so
even in those cases in which a blood infection was proved post mortem. In no
case could the lower border of the spleen be palpated below the costal margin.
Urine. — The urine showed nothing remarkable. At the onset it exhibited
the usual febrile characteristics, and during the height of the fever a trace of
albumen was sometimes observed, but this was considerably less frequent than is
the case with such diseases as typhus and pneumonia, where the symptoms are of
like severity.
Nervous System. — The most marked nervous symptoms were delirium and
coma. Even in the protracted cases the delirium was slight, and of a mildly
delusional character — the patient was, in general, unaware of his surroundings, and
often thought that he was engaged in his ordinary avocations. Muttering was
almost always present. When coma occurred, it was either at the beginning or the
end of the illness. If the former, it was deep, to the point of complete unconscious-
ness ; but it was noted in the two cases in which this was observed that the patient
resisted attempts to touch the region in which the bubo was situated. A curious
feature of this resistance was that it was apparently purposive. The patient made
the same movements of resistance which a perfectly conscious person would make,
showing that, although the higher centres were completely out of gear yet that the
brain-poisoning was not so complete as is commonly seen in the coma of other
42
specific fevers. When the coma supervened at the close of the diseases, it differed
in no Avise from that which is commonly seen ushering in the lethal exitus.
Muscular tremor was rare, and resembled that of enteric rather than that of
typhus. Severe hiccough was present in one instance.
Organs of Special Sense. — Eye. — The eyes were, in general, suffused, but
photophobia was not observed. The pupil was slightly dilated in most
cases, but reacted well to light. Conjunctivitis was occasionally present, and in
three cases there occurred, in the third week of the diseases, a unilateral severe
injection of the eye, which was very painful. This resisted treatment, and
subsided only on the patient's return to health. From such inflammations the
plague bacillus was not recovered.
Ear.- — Deafness was not observed as a symptom, as in some other acute fevers —
e.g., typhus and enteric. Otitis media occurred once, and on that occasion the only
organisms found were the bacillus pyocyaneous and a diplococcus.
Pestis Amhulans. — From the reception- houses four persons who seemed
to be suffering from very slight attacks of plague were admitted, so slight
that had they come under observation without a definite history of contact
they would, apart from a bacteriological examination, be quite unrecognisable.
The importance of the matter is further enhanced when it is considered that in
these cases the buboes were so small that to put a needle into the substance of the
gland was a most difficult matter. The general symptoms which these persons
exhibited have been as follows : — In the onset there was headache and malaise,
associated with sickness, while A'omiting was only occasional. The temperature
was only slightly raised — rarely above 100° F., and sometimes not above 99'6° ; the
pulse was only slightly quickened, and the rapidity of the respirations was not
markedly altered. The face was heavy and drowsy-looking, the eyes injected, and
the tongue furred.
In general, in addition, the patient looked much more ill than the severity of
the symptoms warranted. This look of illness usually persisted for several days
after the symptoms subsided. The seat of the buboes in the seven cases has been
twice in the left axilla, three times in thp sub-maxillary glands, once in the anterior
cervical chain, and once in the sub-occipital glands. The glands have been
enlarged, with some peri-glandular infiltration, and in one case reddening of the
skin. Tenderness has always been present, though not so markedly as in the more
severe cases of typical plague, and this tenderness has usually appeared on the
second day of illness ; it subsided after two or three days, though the swelling of
the glands might not be wholly absent even after a fortnight. The clinical picture
is fairly constant, though, as before remarked, the illness is not of a severity to be
readily diagnosed unless with a definite history of plague contact.
One of these cases occurred in hospital (E. R., case No. 21). in a wardmaid
who was in attendance in the pavilions. As they were for plague, she had received
a protective inoculation of 10 cubic centimetres of Yersin's serum exactly 10 days
previously to her developing an illness in all points exactly resembling that described
above. In this case the buboes were in the sub-occipital region, so that their
puncture was rendered more easy on account of the firm tissue which lay sub-
jacent, and did not involve the same risk as in other cases where the glands affected
lay over the main blood-vessels. Typical cultures of the plague bacillus were
obtained.
Plate A.
Case No. 9.— T. H. M., set. 15.
To shew facies of the plague patients.
Case No. 6 — D. T. M., set. 6. .Case No. 1.— J. B. M., :pt. GO.
Right inguinal bubo, forming abscess and about to burst. . . ftight inguinal bubo, with much surrounding infiltration and cedema.
yamcs Gilmour, Printer, Glasff07v.
43
Clinical Histories, with the Post-mortem REPORTi^-iN Fatal Cases.
* Case No. 1 . — J. B. , aged 60 years, was admitted to hospital on August 28th, his case being certified
as enteric fever. The patient sickened on August 15tli, on -wliich date he was suddenly seized with
snivering, nausea, and vomiting, associated with severe headache and slight abdominal pain. The
symptoms from their onset were so severe as to make him take to bed, where he remained till his
removal to hospital. From August 25th he suffered from diarrhoea, and for tlie 24 hours preceding
admission he was delirious.
On adm'xnon tlie patient's face was seen to have the same dull, heavy, and yet anxious Idok
as described in detailing the case of Patrick Malloy. The pupils were moderately dilated and the
conjunctivae were slightly injected. The tongue was coated with a thick greyish fur in the centre,
while the edges were moist and clean. There was no congestion of the fauces. The skin presented
the same mottling noted before in Patrick M., with the difference that over the abdomen it was
much more profuse. In the right groin was a very large tense red and (Edematous swelling occupying
the situation of the verticle group of glands. This swelling was exquisitely tender and the
tissues surrounding it were so infiltrated as to make the appreciation of individual glands by palpation
impossible. The lymphatic glands above Poupart's ligament were also palpable and slightly tender,
while the skin over the right iliac region, though not reddened, was distinctly oedematous. Elsewhere
the lymphatic glands were not palpable. The temperature was I02'8° F., the pulse was soft and weak
and numbered 72, while the respirations were at the rate of 24 per minute. The abdomen was slightly
distended and rather tense. Ncjthing noteworthy was detected in the heart and lungs, and the spleen
and liver were not enlarged.
Courf:e of Disease. — The patient's condition was all along precarious, delirium was almost
continuous, although slight, and at no time violent. The pulse was feeble, and at no time
during the first 10 days of the disease. Hiccough was present from August 30th till September
8th, though not in a distressing degree. Until the morning of September 2nd the temperature
ran a febrile course varying between 100'6° and 103^. On that morning the patient had a
distinct crisis and the temperature fell to 97'6°, and there was improved tension in the patient's
pulse and he expressed himself as feeling better. After admission the redness and redema
surrounding the swelling in the groin slowly spread until it extended downwards almost to the mid-
thigh and backwards over the buttock. At the same time oedema without redness spread from the
right iliac region until nearly the whole abdominal wall pitted readily on pressure. This was
associated with a distinct increase in the abdominal distension. The inflammatory process reached its
height on Septemder 1st, and after that date there was a slow but distinct subsidence of the l edness
and oedema around the bubo. The oedema of the abdominal wall disappeared, but there appeared
coincident with this considerable oedema of the left foot, with tendency to the formation of pressure
sores. On September 6th a secondary fever, due to the suppurating bul)o, commenced, and the tempera-
ture ranged continuously from 100° to 102°. The discharge from the bubo was copious and serous, and
there was never any attempt at separation of the sloughs. Patient gradually became more feeble,
remained constantly delirious, and died on September 24th (Photograph of bubo, Plate A).
Post-mortem Examination, 26th Septemher, 1900, by Dr. R. M. Buchanan.
External Appearances. — The body is considerably emaciated. On the trunks, arms, and thighs
there is an unusually profuse freckling of the skiu. Over Scarpa's triangle on the right side there is a
large ulcer measuring 2^ inches by 1§ inches. Its margin is sharply defined, and its floor is a smooth
yellowish-white slough. The margin at the inner side is undermined extensively, and a small sinus
opening is discharging pus from the upper end of the ulcer.
Cheit. — Both lungs are firmly adherent posteriorly, the right especially. Both are hypera;mic
anil oedematous posteriorly — the right more than the left. A considerable amount of purulent
secretion is present in the bronchial tubes of the right lung.
Heart. — The myocardium is pale, and pri-sents on section the characters of cloudj' swelling.
There are no ha3raorrhages in the muscle or pericardium. The curtains of the mitral ami aortic valves
present much fibrous thickening.
Liver. — The liver is of a normal size. It shows slight hyperceraia.
The spleen is slightly enlarged, and its tissue firm.
Kidneys. — The capsule of each kidney is removed with difficulty, exposing a granular surface
with a number of cysts. Numerous small yellow foci are widely distributed over the surface of both
kidneys. They have the appearance of small abscesses, but are fii-m and not surrouuded by a zone of
hypersemia.
Stomach. — A small ulcer is found near the pylorus on the posterior wall.
The in.testini'S, pancreas, and bladder present nothing remarkable.
The right iliac fossa and the right side of the pelvis are occupied by a large partitioned abscess, a
large portion of which impinges on and involves the wall of the bladder. From this abscess a sinus
runs upwards along the surface of the psoas muscle to the right side of the lumbar vertebrae, and
another leads from its lower limits downwards to discharge from the ulcer on the thigh. The abscess
cavities contain creamy pus and masses of necrotic tissue. A purulent infiltration of the subcutaneous
tissues is traced nearly half-way down the thigh.
The lejt ingumal glands show some enlargement, but no evidence of inflammatory action.
A pure culture of bacillus pestis was obtained from puncture of the bubo on the night of admission.
* The Temperstni'4 Charts of those cases marked with an asterisk are given on the lithographed plates at the end of this
Section.
44
* Case No. 2.— Mrs. T., fet. 40, admitted August 2oth, 1900.— Certified "Typhus Fever."
Patient took ill ten days prior to admission, the onset of the illness being severe Headache,
sickness, and vomiting were the most marked symptoms. Patient was three months pregnant, and
aborted four days before admission. It seems to be quite certain that at this time she made complaint
of pain in the left groin, but when this first appeared could not be definite!}' ascertained, as patient
was very ill, and lier mental condition much obscured. On admission the temperature was 103 "2° ;
pulse, 128 ; respiration, 44. The face was fluslied and heavy, the eyes suffused, and the tongue dry.
Tlie pulse was very soft and feeble, resembling that of typhus. Nothing worthy of record was dis-
covered in the lungs. The discharge from the vagina was scanty and sanguinolent, M'ith no bad odour.
In the left groin, above Poupart's ligament, there was a large swelling of about 4 inches in length and
2 inches in breadth, which was very tender. The skin over this swelling was markedly inflamed.
Patient's temperature came down after admission by rapid lysis, reaching the normal on the morning
the crisis, felt fairly well, but the bubo became secondarily infected, and she had a continued
of August 28th. From cultivations made after puncture of the bubo on August 29th, a pure culture
of B. pestis was recovered, after an unsuccessful attempt to recover the bacillus on the previous day.
. . The patient, after the crisis, felt fairly well. The bubo ruptured spontaneously on September
5th, aud discharged a sero-purulent fluid. Secondary infection of the bubo occurred, and patient had
a remittent pyrexia until 16th September, when she had a rather severe rigor, and examination of the
chest showed the presence of a left- sided pleurisy. Thereafter the temperature remained highly
febrile for two daj'S, after which it resumed its previously remittent type, the pleurisy at the same
time disappearing. On 22nd September a similar dry pleurisy on the right side was ushered in by
rigor and rise of temperature, which lasted for three days. On 25th September pain in the left ear
was complained of, and next day a free discharge of pus through the external auditory meatus
occurred, after which the temperature fell to normal, and remained steadily so until dismissal. By
October 2nd the ear was completely healed. Cultivation made from the discharge from the ear showed
marked growth of B. pyocyaneus and small colonies of adiplococcus, but no B. pestis. Convalescence
was good.
* Case No. 3.— P. F., admitted to Hospital, 29th August, 1900. Patient took ill on 14th Aiigust
with headache, sickness, and vomiting, diarrhcea, and extreme malaise. Two days later he
complained of pain in the left groin, and, examining the region for himself, he discovered a
swelling, of wliich he was unable to state the exact size. The diarrhoea quickly subsided, whilst
the symptoms, especially the Vomiting, persisted for more tlian a week. The swelling in his left
groin steadily increased and remained intensely tender till admission.
On admission, temperature was 103" ; pulse, 86 ; respiration, 36. The patient was evidently
acutely ill, the face drawn and anxious-looking. The eyes were suSused and the pupils slightly
dilated. The skin was dry aud hot, and the lips tended to crack. The tongue was very dry, except
at the edges, and there was a brownish fur on the dorsum. The pulse was very small and feeble.
The heart's sounds were muffled. Nothing noteworthy was discovered in the lungs. In the left
inguinal region was a large swelling over which the skin was reddened and inflamed. It filled up the
whole groin, and on palpation was found to be very hard and tender. This swelling was evidently
glandular in origin, and the tissues in its neighbourhood were markedly cedematous. 'J'here
appeared to be little or no involvement of the glands above Poupart's ligament.
During the first few nights after admission patient was delirious, and remained so until the
temperature fell to normal, which occurred in the morning of 3rd September. On 6th September,
slight ichorous discharge made its appearance at the site of a puncture made in the bubo on the night
of admission. The skin at this point began to necrose, and on 9th September the sloughing skin was
cut away to admit of free drainage. During this time, and up till 7th September, a hectic temperature
was maintained, but on that date a large mass of necrosed tissue was removed from the groin, after
which the temperature became normal, and the wound granulated until, by 6th October, it was
completely healed.
On 6th September the suffusion of the right eye had passed away, but there was present a most
intense conjunctivitis of the left eye. This condition was very troublesome, and did not disappear
iintil convalescence became fully established.
The patient was left greatly enfeebled by his illness, and convalescence was very slow (Photo-
graph of bubo, Plate A).
Case No. 4. — J. C, reported page 65.
*Case No. 5. — Mrs. M. , aged 40 years. Admitted to hospital August 25th. Case certified as
" enteric (?)."
History. — The patient on the night of August 10th was at the wake of a Mrs. B. On admission
the patient stated that she was first seized on August 20th with shivering, vomiting, severe headache,
diairhcsa, and slight pain in the abdomen. Next day she felt uneasiness in the right groin, and on
examination she found a small swelling which was very tender. The general symptoms became more
urgent and the swelling in the right groin increased rapidly in size and in tenderness. During the
whole of her illness she was confined to her bed.
Condition on Admission. — The patient was quite intelligent, but looked very ill. The face was
slightly flushed and wore a rather anxious expression. The pupils were moderately dilated, but there
was no injection of the conjunctivas. The tongue was moist and only slightly coated in the centre
with a whitish fur. The skin was hot and dry, and no eruption was noticed on any part of its surface.
In the right groin there was a mass evidently composed of enlarged lymphatic glands surrounded by
45
inflammatory tissue to the extent of obliterating the fold of the groiu. T^e skin over the mass and
for a considerable area around about, particularly laterally, was deeply reddened and edematous.
-Over this area the tenderness was extreme, much exceeding that usually elicited in ordmary infective
buboes. At the upper border of the swelling deep palpation showed that numerous glands in the
deep group of lymphatics were also enlarged and tender, but there was practically no infiltration of
the cellular tissue of this region. The skin over the right iliac region was normal in appearance. The
glands in the left groin and in the axillary and cervical regions were not palpable. Nothing
notewortliy was discovered in the heart or in the lungs. There was no enlargement of the liver or of
the spleen. The temperature was 102'' F. The pulse was soft and full, numbering 92 per minute.
The respirations were easy and numbered 28. In the evening the patient complaiued of very severe
headache confined to the frontal region. The temperature was 103 '4° and the pulse was 112. while
the respirations had increased in rapidity to 30 per minute. On Awfiist S6th there was practically no
change iu the patient's condition. The morning and evening temperatures were respectively 102" and
lOrS", and the corresponding pulse-rates were 72 aud 80. On A ugimt 27th the morning and evening
temperatures were 102° and 100 ■4", and the pulse-rates were 76 and 80. Though the respiration-
rates corresponding to these were respectively 30 and 26 there was no evidence of any pulmonary lesion.
August 2Sth was the day of the crisis, the temperature falling during the day from 101 "4" to 98 '6°, the
pvilse showing a corresponding drop from 78 to 64. At the same time the headache, which had been
a clamant symptom up till that date, disappeared, and although no obvious change had occurred in
the bubo in the right groin the tenderness was distinctly less. The patient also expressed herself
as feeling much better. After the crisis patient's recovery was continttously good. The bubo
gradually subsided and spontaneously ruptured. For a considerable time healing was slow and a
thin serous discharge continued for some weeks ; from this the bacillus of plague was not recovered.
She left well on October 6th.
Bacteriological Examination. — Four hours after admission a puncture was made into the glandular
mass in the right groin and some blood was withdrawn. From this cover-glass films were made and
glycerine agar tubes were inoculated. Immediate examination of the films after staining with gentian
violet showed the presence of considerable numbers of short bacilli morphologically identical with the
bacillus pestis. The inoculated tubes were incubated at 37° C, and 24 hours later a faint white
surface-growth had appeared composed of small translttcent colonies. Microscopical examination of
cover-glass preparations made from these colonies stained with gentian violet showed, as in the
previous case, that they were composed of short, thick bacilli with rounded ends, showing for the
most part well-marked bipolar staining and occurring frequently as diplobacilli. When treated by
Gram's method the bacillus was decolourised. The appearance of the cultures and stained films placed
the diagnosis of the organism as bacillus pestis practically beyond a doubt ( Photograph of bubo,
Plate A).
Case No. 6. — D. T., reported page 65.
Case No. 7. — P. M., aged 21 years, admitted August 25th, 1900, his case being certified as
" enteric (?)."
History. —Patient was living in the same room as his sister, who sickened on August 19th, and
died on the 21st. As the patient was not in a condition to give an account of himself, the information
was obtained from his mother, who volunteered the following history : — Until three days prior to
admission the patient appeared in his normal state of health. On that date (August 22nd) he suddenly
experienced a shivering, associated with sickness, vomiting, diarrhoea, and pain in the abdomen.
During the night the patient was evidently delirious, and delirium was a notable feature of his illness
untd the time of admission. With the exception of measles and whooping-cough patient had suffered
from no other infectious disease.
Condition on Admission. — On admission the patient looked extremely ill. He was nearly in a
state of coma. The face generally was of a greyish colour with a more marked circum-oral
pallor. In spite of the sttipor in which the patient lay the expression of the face was distinctly
-anxious ; there was marked knitting of the eyebrows, the ej^es were widely open, and the conjunctiv;e
were slightly congested. The respirations were slow, numbering 18 per minute, and sighing. The
skin generally was hot and dry. It was covered with a faint purplish mottling most marked across
the lower part of the abdomen, the arms, and the buttocks. The characters of this eruption somewhat
resembled the sub-cuticular mottling of typhus fever. The tongtte was moist, and covered in the centre
with a thick greyish fur, while the edges were clean and red. There was no congestion of the fauces.
There was in the upper part of the deep cervical chain a" swelling composed of one moderately enlarged
and several slightly enlarged lymphatic glands. The tissues surroitnding these were markedly infil-
trated and the skin was reddened and oedematous. Manipulation of this swelling was evidently very
painful. There was no enlargement of glands in the right cervical region or of the superficial chain
on the left side. The right axilla was filled with a large mass evidently composed of lymphatic glands
embedded in cedematous cellular tissue. Here, again, the skin was red and oedematous and movement
of the arm or even the lightest palpation gave rise to exquisite pain, evidenced by the wincing of the
patient even in his comatose condition. In the left axilla a few glands were slightly enlarged, but
not tender. No enlargement of glands was apparent in either groin. The temperature was 103 6,
the pulse was very soft and easily compressible, and numbered 128 per minute. The lungs revealed
nothing noteworthy on physical examination. The cardiac sounds were pure ; the first sound was
rather weak. The abdomen was not distended and was neither painful nor tender. There was no
apparent enlargement of either liver or spleen. Exploratory puncture of the glands of the axilla was
46
performed, and an immediate examination of films prepared from the blood withdrawn revealed the
presence of a considerable number of bacilli morphologically identical with the bacillus pestis of
Kitasato.
On August 26th the general condition of the patient remained much the same, though the
respirations were more rapid, numbering 28 per minute, but the local conditions had undergone
marked alteration. In particular the Ij'mphatic glands on the left side of the neck before mentioned
were much more enlarged and the superficial glands on that side were now considerably involved.
Late in the afternoon the glands in the left groin were easily palpable and slightly tender. The
cedema in the right axilla was more extensive, involving the anterior border. The spleen was found to
be enlarged to percussion, though not palpable below the costal margin. The temperature at 6 A. M. was
102-4° and at 6 p.m. 104 '4°. The pulse in the morning was 112 and in the evening 132, and even softer
than on the previous day. On this evening the glycerine-agar cultures made after puncture of the
glands on the 25th and incubated for 24 hours at 37° C were examined. There was a faint surface
growth composed of minute whitish translucent colonies. Cover-glass preparations were made from
this growth and stained with an aqueous solution of gentian violet. These showed the presence in
pure culture of a short bacillus with rounded ends, tending to run in pairs and showing well-marked
bipolar staining. The bacillus was decolourised by Gram's method. The character of the culture
and the morphological appearances of the bacillus and its staining reactions confirmed the diagnosis
made from the examination of the films on the 25th that the organism under consideration was. the
bacillus pestis.
On August 27th the local conditions had if anything advanced, but the general condition of the
patient was rather better. There was a little less mental obtuseness, thougli it was still with great
difficulty that he could be got to show his tongue. This improvement, however, was not maintained.
Bj' mid-day the patient was cyanosed and the pulse was notably weaker. He sank rapidly and died
at 3.35 P.M.
Post-mortem Examination, 28tli August, J 900, by Professor Muir.
The body of the deceased is that of a fairly well nourished though rather slightly built man.
There is a distinct swelling in the right axilla and also a well marked swelling in the left side of the
neck. In the left groin there is a fairly distinct swelling and also a very slight one in the right groin.
Weil marked hypostasis and diffuse congestion exist in the region of the neck.
Thorax. — The pericardium contains about half an ounce of blood stained serum. The light side
of the heart is greatly distended with dark coloured partially clotted blood, while the left side is
rather contracted and empty. The cavities are of normal size and the valves appear healthy. The
heart muscle is rather paler than normal, but not specially soft. Over the apex of the left lung are a
few old adhesions. There is no fluid in the pleural cavities. The lungs show marked hypostatic
congestion and also some collapse but no pneumonia. The glands at the root are not visibly affected.
The bronchi contain some purulent mucus. The right lung is adherent all over, especially over the
lower lobe. There is an old cicatrix on the chest wall over this part (resection of rib ?) This lung is
otherwise in a practically similar condition to the other.
Abdomen. — The peritoneum is normal. The spleen is enlarged, weighing 12^ ounces, the increase
being chiefly in breadth. The consistence is softer than normal, but by no means diffluent. The pulp
presents a pale and mottled appearance and the Malpighian bodies are small and distinct. The liver
is somewhat swollen, pale, and soft, and evidently the seat of cloudy swelling in a marked degree.
Both kidneys are somewhat swollen and soft, owing to cloudy swelling of the cortex. No hemorrhages
exist. The pancreas is slightly swollen and softer than the normal. The suprarenal bodies also are
rather swollen and softened.
Lymphatic Glands. — The glands in both groins show enlargement especially in the vertical gmup
along the vessels. They are somewhat irregular on the surface, extremely tense, much congested, and
show small hsemorrhagic points. The substance is rather softer than normal, and there is no evidence
of suppuration. The enlargement also affects the glands along the inguinal vessels and some of them
are distinctly hcemorrhagic. The retro -peritoneal glands along the aorta show great swelling, but none
of them reach a great size. In the right axilla there is a large swelling almost as large as a closed fist,
composed of a mass of enlarged glands bound together by infiltrated tissue. The largest single glands
are about the size of a small plum. They are of a dark red colour, owing to the diffuse hfemorrhages
into their substance, and here and there show partial softei}ing. The periglandular tissue is the seat
of a gelatinous cedema with diffuse hajmorrhages. The involvement of the glands extends upwards
behind the clavicle. On the left side there is great enlargement of the cervical glands below the
sterno- mastoid muscle, where there is a large irregular mass ; the axillary glands are also affected,
though to a much less degree than on the right side. The amount of hemorrhage is extreme,
some of the glands presenting a deep crimson colour and being also much softened. Here, also, there
is much inflammatory infiltration. The glands in the upper mediastinum are also enlarged and
surrounded by inflammatory oedema. A scraping from one of the inguinal glands shows enormous
quantities of the bacillus pestis.
Case No. 8. — W. M., aged three years, 57 Thistle Street, Glasgow, was admitted to the
Belvidere Hospital on August 25th. This child is the son of Mrs. M. , and is stated by his mother to
have become ill on August 21st. His symptoms appear to have been very slight. They consisted
solely of slight pain in the abdomen and general malaise. On admission the temperature was
99'6° F., the pulse was lOG, and the respirations were 22. The child's expression was dull and the
face was very pale. There was a markedly enlarged gland in the submental region of about
the size of a large marble. This gland seemed to be hard and adherent, and the skin above it was
47
slightly red. This gland, the mother distinctly stated, was not present prior to this illness. The
glands in the axillae, neck, and groins were palpable, but were not markedly enlarged. Those in the
right groin were the most obvious. Nothing noteworthy was detected in either lungs, heart, liver, or
spleen. On August 26th the temperature reached 100 '6° but without any aggravation of the
symptoms ; since then the temperature had been normal and the child fairly well. The submental
gland above noted decreased steadily in size till at the end of 10 days it was barely perceptible. No
bacteriological examination was made in this case.
*Case No. 9. — T. H., aged 14 years, was admitted to hospital on August 29th, his case being
certified as " enteric fever (?)." He sickened on the 23rd. On the 23rd the patient was seized with
headache, retching, and pain in the back and right axilla. He was fevered, restless, and delirious
at nights after the onset of illness. The pain in the right axilla rapidly became worse, and was
followed by pain in the left side of the neck and in the right groin.
On admission the patient's face was flushed and the expression was dull and heavy. He had the
same apprehensive expression described in previous reports. The pupils were dilated and the con-
junctivae were fairly clear. The lips were dry and there was well-defined circum-oral pallor. The
tongue was coated in the centre with a greyish white fur, biit was clean and moist at the tip and
edges. The skin was hot and dry ; it presented a faint mottling which was most marked on the back,
flanks, and buttocks. As the patient lay in the dorsal decubitus the right thigh was slightly abducted
and the leg was semi-flexed. There was a general enlargement of the glands in the groins, the axilla;,
and the neck. The glands in the right axilla and the right groin were distinctly the largest and
exceedingly tender. No complaint of pain was made on palpation of the glands of the left groin, the
left axilla, or the neck. The skin over the right axilla and the right groin was slightly reddened, but
was not oedematous. The temperature was 104 'G" F., the pulse was 140, and the respirations were 26.
The pulse was easily compressible, but quite regular. The respirations were easy. Examination of the
lungs revealed nothing except a few sub-orepitant rales in the left baso-lateral region. On auscultation
over the cardiac area a faint systolic murmur was heard both at tlie apex and in the pulmonic region.
The abdomen was slightly' tympanitic to percussion, especially in the right iliac region. The spleen
was enlarged both in its longitudinal and transverse diameters.
Course of Distaf-e. — Until September 2nd the general condition remained the same. There was
no visible increase in the size of the enlarged glands. He was \'ery restless at nights, having delirium
with delusions. Fever was high, the temperature ranging from 103° to 105°. The pulse was rapid
and feeble. Considering the stress and duration of the fever there was a notable absence of some of
the commoner symptoms of high fever — viz., subsultus tendinum and dryness of the mouth and tongue.
Headache was constantly present. On August 31st a marked injection of the right eye was observed,
with slight prominence of the eyeball. On September 2nd a Cijnsignment of Yersin's anti-plague
serum was received. It was decided, after consultation, that this patient was a suitable snbject for
serum treatment. Accordingly, at 12 midnight, an intravenous injection of 15 cubic centimetres, and
at the same time a subcutaneous injection of 25 cubic centimetres of the serum, were made. The
patient slept well after the injections, and perspired freely for the first time since admission. Next
day brought no remission of the temperature, but the buboes in the right groin, which had been
extremely tender on the previous day, could now be touched without the patient experiencing more
than a slight sense of pain. A like lessening in the tenderness of the axillary bubo was also quite
manifest. A fall of temperature amoimting to 4° occurred on the night of September 3rd, and since
then the improvement has been maintained. On September 9th there was an recurrence of pain in the
right groin, associated with a temperature oscilating between 98° and 101°. After this the convalescence
was uninterrupted and good.
A pure culture of the bacillus pestis was obtained after puncture of the axillary bubo on the day
after admission (Photograijh to illustrate plague facies, Plate A).
Case No. 10. — R. M., reported page 65.
Case No. 11. — W. W., set. 42, admitted 20th September, 1900. Patient was working on a ship
laid up for repairs on return from India, and four weeks prior to admission he became ill. His
general symptoms were very indefinite. A large and tender bubo on the left groin, which
apparently made its appearance with the onset of the general symptoms, was the chief cause
of complaint. This was incised by his own medical attendant a week after its appearance
without any pus being found. A fortnight later it was again incised, but again no pus
was found. The next week a profuse discharge of pus from the incision commenced, and patient
was sent to the Western Infirmary, and thence to Belvidere on the suspicion of his having plague.
On admission he was eviiiently very ill. The temperature was 100° ; pulse, 88 ; respiration, 50. His
intelligence was clouded, and he was unable to give any satisfactory account of his illness. The face
was livid and congested, and the eyes suffused and wandering. The tongue was dry, and coated with
a yellowish-white fur. Nothing abnormal was discovered in the lungs. In the left groin there was
a large swelling, over which the skin was very livid, and which was bisected by a lai'ge vertical
incision, from which a large quantity of ichorous fluid was exuding. In this fluid, on direct
microscopical examination, numerous degenerateil bacillary forms were observed free in the fluid,
and also contained in the leucocytes. No definitely typical forms of B. pestis, however, were seen,
and none could be isolated by culture. The bowels were constipated, and the urine contained a
trace of albumen.
48
During llie lime this patient was in liospital his temperature ran a coutinuous hectic course.
He was delirious, tending occasionally to become violent. The discharge from the bubo became very
profuse and ichorous. On •2nd and 3rd October, 55 cubic centimetres of Yersin's serum were
administereii without any effect. He gradually sank, and died on 6th October. It is to be noted,
however, that the bacillus pestis was recovered post-mortem.
*Case No. 14. — A. D., aged 18 years. On the evening of August 28th he was seen on account of his
having been taken ill. The patient was very drowsy, so much so that he manifested no reflex on touching
the conjunctiva with the finger. There seemed to be no suspicion that this was due to alcohol. Head-
ache, sickness, and vomiting had been marked and severe just before arrival, but had temporarily
subsided. The temperature was normal, and the pulse was 70. All the glands of his body which were
accessible to palpation were examined without anything abnormal being discovered. Next morning
the patient was somewhat better, but he was kept in bed. In the afternoon a recurrence of the
headache and vomiting took place. The sub-maxillary glands in the left side were complained of and
fouud to be enlarged. The temperature was 99 '6° F. He was straightway sent to hospital.
On admission the patient had that heavy and obfuscated look which has been already described
in such cases, with injection of the conjunotivse and slight dilatation of the pupils. The sub-maxillary
glands were considerably enlarged and painful on palpation. Next morning the temperature was 99°,
at which elevation it remained all day, but a consistent normal temperature was not maintained till
the seventh day of the illness. The pulse, on admission, was 72, and had, on the latter date, declined
in rate to 50, while the respiration rates were respectively 24 and 20.
The tenderness of the glands persisted for about three days, when it gradually subsided, but the
swelling has not, even at the date of writing (September 18th), completely disappeared. The aspect
of illness was more marked and lasted longer than would have been expected from the local conditions
had the latter been due to ordiDary causes. As possible causes of the condition which were definitely
excluded may be mentioned caries of the teeth, faucial catarrh, and nose or ear mischief. Puncture
of the gland was attempted only once, as it immediately overlay the deep vessels of the neck, and the
cidtitre proved sterile. It is, however, open to doubt whether the needle actually penetrated the
substance of the gland.
*Case No. 17. — A. R., reported page 67.
Case No. 18. — G. H., set. 46, admitted September 12th. — Patient was admitted about midnight.
He was evidently ill. His intellect was clear but his expression anxious. He made no complaint
of pain, but in the right groin a marked swelling was noticed about the size of a hen's egg. The
tissues round about were infiltrated and the skin reddened. It resembled the plague bubo, as we
had already seen it, but there was a complete absence of that tenderness which had been present in
all the other cases.
As patient came in very late, and was much exhausted by the ambulance drive, he was not
subjected to any physical examination. He collapsed early in the morning, and died of acute
heart failure.
Temp, on admission, 103°.
Post-mortem Examination, loth September, 1900, by Dr. R. M. Buchanan.
External Appearances. — A well nourished, well developed body, showing a small number of
petechiae scattered over chest, abdomen, and thighs. Over the upper part of the right thigh there
is some fulness, in the form of an indefinite diffused slightly oedematous swelling, over the centre of
which the skin has a yellowish tint.
Chest. — The -pericardium contains about 1 ounce of clear fluiil. The heart presents subpericardial
haamorrhage over the base of the left ventricle, and its muscular tissue shows parenchymatous
degeneration. The valvular structures are normal.
In the right pleural cavity there are about 20 ounces fluid, and about 10 in the left. The Imig.'i
are free from adhesion, oedematous and hypertemic. The bronchial glands are deeply pigmented,
enlarged, and very hypersemic, and the cut surfaces reveal some hasmorrhage.
The tissues of the posterior mediastinum are infiltrated with blood. The nech is the seat of an
extensive extravasation of blood. The hemorrhage, which is more widespread on the right side than
on the left, is mainly in the loose intermuscular connective tissue, but is also evident in the substance
of the muscles, especially in the sterno-mastoid.
The cervical lymphatic glands are hypercemic, and considerably enlarged.
Abdomen. — The spleen is "of normal size, but the cut surface shows the pulp slightly soft and
hypersemic.
The liver is of normal size. On section the tissues present the homogeneous glancing appearance
of cloudy swelling in a marked degree. The gall bladder is adherent to the duodenum.
The Hdntys are large and very hypersemic. In the loose adipose tissue of the hilus of each kidney
there is considerable extravasation of blood.
In the mucous membrane of the stomach and inte/tines numerous small punctiform haemorrhages
are found.
49
Glands. — The vertical set of the right ingximal glands has undergone enlargement, and the con-
nejtive tissue for some distance around is cedematous, the fluid near the glands being of an amber
colour. The glands are firmly matted together, forming a diffuse swelling. On median section of
this swelling it is seen that one of the glands has attained the size of a walnut, while the others are
much smaller. They are all intensely hyperasmic, with numerous haemorrhages, giving the cut
surface a brownish red mottled appearance. The large gland is also somewhat friable. The tissues
immediately around the glandular mass are occupied by extravasated blood in large amount.
The iliac and pervertehral glands of the same side are hypertemic and slightly enlarged, and the
same is to be said of the inguinal glands of the left side.
■* Case No. 19. — C. M'M., aged 30 years, admitted to the Belvidere Hospital on September 9th.
The liistory of the illness obtained from his friends, and afterwards verified by himself, was to the effect
that for about a week before his admission to the hospital he had suffered from moderately severe
headache and slight malaise, but he continued at his work until the morning of September 8th, when
he had a rigor, with increased severity of the headache and sickness, although vomiting was absent.
By noon he was unconscious, and he was delirious all night, and very violent.
On admission tiie patient was evidently extremely ill. His face was of an ashy colour, with a
more marked ring of pallor round the mouth. The conjunctivce were slightly injected and the pupils
were contracted, in contrast to the more common dilatation observed in the other cases. Tlie tongue
was moist, with a white fur on the dorsum, but not markedly injected. The temperature was
105"8° F. , the pulse was 134, and the respirations were 40. The pulse was soft and compressible, but
full. There was no evidence that the patient was in the least conscious of his surroundings. When
left alone he tossed restlessly in bed, but Ijetraycd considerable anxiety in his face. On being handled
he resisted so strongly that it was impossible for the nurses to wash him. This resistance was
extremely marked if the palpation of his left axilla was attempted. In this situation a group of
glands was found which were enlarged and acutely painful. (It is to be noted here that the move-
ments of resistance made in opposition to the examination of this bubo resembled those of a person
conscious of his actions, and not the purposeless movements usually made in the delirium of tj'phus or
enteric fever.) The only bubo found was in the left axilla; elsewhere, though the glands were
slightly enlarged, the enlargement was no more than is often met with in healthy persons. The other
organs, on examination, showed nothing worthy of note. At 12 midnight 20 cubic centimetres of
serum (Yersm's) were injected into one of the brachial veins, and a like quantity into tlie subcutaneous
tissue of the abdomen. This was done with considerable difficulty owing to the struggles of the
patient. At the end of six hours it was seen that the patient had had a light sweat, and that the
temperature had fallen four degrees. The pulse-rate was reduced to 108, and the respirations had
fallen to 34. The pain in the axilla was markedly lessened, and the surrounding oedema was much
less. By the evening the glands could be palpated without undue resistance. A puncttire, for the
purpose of completing the diagnosis, was made, with the result that the clinical diagnosis was
confirmed microscropically. By next day the cultures made at the same time showed typical growths
of the bacillus pestis. On this day the temperature was throughout 100°, and the pulse ranged from
64 to 7G. The patient felt quite well, and desired to get up. On questioning him it was found that
he remembered nothing from mid-day on Saturday (September 8th) till the evening of Monday (the
10th), when he found himself in the hospital. Since the latter date the improvement has been
const:int, with the exception of a rise of temperature to 101° on the evening of the 14th, associated
witli a sliglit recrudescence in tenderness of the glands in the left axilla, wliich subsided on the next
day. The pulse, however, was still weak, and the heart-sounds somewhat toneless. On the 19th and
20th there was a rise of temperature, associated with pain and discomfort in the knee-joint and in the
left thigh, as well as in the arms, due in all probability to the serum injected on the 9th. From this
point convalescence was interrupted.
* Case No. 20. — Mrs. B., ajt. 29, admitted 14th September. The illness began on tlie day prior to
admission with severe frontal headache and rigor, pains in limbs, and severe pain in the back. There
was no sickness, vomiting, or diarrlioja. On the morning of the day of admission pain was felt in tlie
right groin, and on examining this region she perceived a small lump, which was very tender to the
totich. Temperature on admission was lOO'S", the pulse was 96, and the respirations were 32.
On admission patient did not look very ill, but the face was somewhat flushed and anxious. The
eyes were slightly injected, and the pupils normal. The tongue was moist and slightly furred. The
heart and lungs, on physical examination, showed nothing uoteworthy, with the exception of a few
wheezing rales.
A bubo was present in the right groin, chiefly involving the horizontal chain of lymjjhatic glands
below Poupart's ligament. The vertical chain was only slightly involved, and there was some cedema
in the surrounding connective tissue. The skin in Scarpa's triangle was reddened. This bubo was
exceedingly tender.
Next day the patient was somewhat better, and as the temperature had fallen no serum was
given. On the 16th the temperature was still normal, but the symptoms advanced during the da}',
and in the evening the temperature rose to 101 ■2. The bubo was now considerably larger, the
connective tissue more ojdematous, and the skin more inflamed. 20 cubic centimetres of serum were
therefore injected into the skin of the abdomen. Next day the temperature had fallen and the pain
50
in the bubo considerably abated. On tlie morning of the 18th, however, the local conditions had
again advanced, with extension to the deep inguinal glands above Poupart's ligament. The oedema
was much increased, and the redness had extended down the side of the thigh. Consequently 20.cubic
centhnetres of ssrum were injected into a vein of the right arm. Towards evening a great improve-
ment in the patient's condition had taken place, and she both looked and felt very much better. Next
day the temperature was normal, and, falling to slightly sub-normal in the evening, remained so.
Improvement was rapid ; the bubo softened and ruptured spontaneously on September 23rd. Con-
valescence was good.
A pure culture of the plague bacillus was obtained on admission from the bubo. On rupture the
discharge proved sterile, but contained many degenerate forms of bacilli, some being free and others
contained in the leucocytes.
Case No. 21. — E. R., aged 21 years, was a wardmaid in the wards at the Belvidere Hospital
reserved for plague. On September 3rd, as a prophylactic measure, 10 cubic centimetres of Yersin's
serum were injected subcutaneously. This produced none of the effects often resulting
from it, such as urticaria or articular pains. On the 13th headache and pain in the back
were complained of, and nausea was also present, but there was no vomiting. The patient,
however, felt very unwell. On the 14th the headache and malaise still continued, and, in
addition, tenderness and stiflfness in the back of the neck were complained of. The eyes were slightly
injected, and the face was flushed and its expression heavy. The tongue was slightly furred, but
was otherwise normal. Neither diarrhcea nor constipation were present. The temperature was
normal and the pulse showed nothing noteworthy. Behind the ears, in the posterior triangle of the
neck, there was on each side a markedly enlarged lymphatic gland — that on the left side being of
about the size of an almond, and that on the right side of the size of a bean. Puncture was made into
the gland of the left side, and cover-glass films and cultures were made. These showed a bacillus
morphologically indistinguishable from the bacillus pestis. By the loth the tenderness of the glands
had subsided, and since that date they have been decreasing in size. The patient was discharged
well.
* Case No. 22. — Mi-s. M., 20, admitted September 15th. The duration of the illness was a little
doubtful, owing to the difficulty of obtaining an accurate history of the patient from her friends.
It was, however, certainly under 48 hours. The onset had apparently been very severe headache,
pain in the back, diarrhoea, and great prostration being the most marked symptoms. The
patient was very much emaciated, and had undergone great privation for some time prior to
admission. The face was pallid, the lips dry and covered with sordes, and the tongue likewise
dry, with a brown fur. The temperature was 102"6 ; the pulse, which was soft and rapid,
numbered 140, and the respirations 40. The patient was months pregnant, and on admission
labour was already in progress. The only phj'sigal signs observed in the lungs were some subcrepitant
rales at both bases. There was a large, indurated, and very tender bubo in the left inguinal region.
No rash was observed. On the evening of admission, 20 cubic centimetres of serum were injected
intravenously, and 20 cubic centimetres into the area immediately below the left groin, so that it
might drain directly into the bubo. At the time of the injection the temperature had fallen to 99 '6,
and the patient was much collapsed. At 4 a.m. the os was found to be fully dilated, and as by this
time the patient's general condition was one of extreme gravity, instrumental delivery was at once
effected. The child was born asphyxiated, and after much trouble was resuscitated. No gross lesion
of the placenta could be observed. After the birth of the child the patient rallied a little. The
temperature rose to 103 '8 ; the tongue and lips became cleaner and moister, and the patient expressed
herself as feeling a little better. On September 16th, 20 additional cubic centimetres of serum were
injected subcutaneously into the abdominal wall. During the day the patient's state became more
and more grave, and she died at 11.50 p.m. A pvire culture of the plague bacillus was obtained from
the bubo on admission, and also from the blood. On examining the bubo after death no plague
bacillary forms which did not bear evidence of the most profound degeneration could be discovered,
though in the spleen and other organs of the body typical uncultured forms were easily seen.
Post-mortem Examination, 18th September, 1900, by Dr. R. M. Buchanan.
Exttrnal Appearances. — The body is very well developed and well nourished. The abdomen is
much distended, and presents the greenish discolouration of commencing putrefaction. With this
exception, the general surface of the body is pale. There is a slight fiilness observed over the area
of Scarpa's triangle on the right side.
Chest. — The heart is of firm consistence. Over a small area at the apex of the left ventricle there
is a grotip of small hemorrhages under the pericardium, extending into the muscle superficially.
The muscle is slightly paler than normal, and a slight degree of cloudy swelling is evident. The
valvular structures are normal.
The lungs are hyperEemic posteriorly and oedematous.
Abdomen. — The liver, splf.cn, and hidneys are hyperoBmic.
The iiterua in its form, size, and position, is characteristic of recent delivery. It is firmly
contracted, and the internal surface is lined by a filmy coating of blood clot.
Glands. — The right inguiral glandn are considerably enlarged. The vertically disposed glands
■ together with a retroperitoneal (lower iliac) gland form a chain in which each gland is very similar in
51
size and appearance. On section they are found to be fully lialf-an-inch in diameter, while the cut
surfaces are of firm consistence, intensely liyperKmic, and darkly mottled. The surrounding tissues are
oedematous but free from haemorrhage. The retroperitoneal gland is the largest of tlie group in
virtue of its elongated shape. The p7 evertebral glands in the same side are also notably afl'ected. The
glands generally, including those of the mesentery, are slightly enlarged and hyperfemic.
* C:ise No. 23. — Mrs. M., set. 41, admitted 16th .September. The history of the illness was a
little difficult to obtain accurately, as the patient was considerably out of sorts for some weeks,
but it jarobably began tvfo days prior to admission. The chief symptoms were severe headache and
general malaise ; on the day prior to admission she noticed a small tender swelling in the right groin.
On admission, temperature was 102 '4, the pulse was 104, and the respirations were 24. Patient
complained of very severe headache. The tongue was dry, and the face very anxious looking. In the
right groin there was a small bubo about the size of a pigeon's egg which was exceedingly tender.
There was also some induration in the tissues round the gland, but the skin was not adherent. The
bowels were constipated. Patient was evidently ill. On tlie evening of admission '20 cubic centimetres
of serum were injected into the abdominal wall. Next day thei-e was no change in the patient's
condition, with the exception of the fact that the bubo was, if anything, less tender, and, as on the
18th, no further improvement had taken place, 20 cubic centimetres of the serum were injected into
a vein of the right arm. In the evening great improvement had taken place in the patient's sense of
wellbeing, and she expressed herself as feeling very much better. The tongue was more moist, the
headache had gone, and the pain in the bubo was much less. From this point convalescence was good,
no rise of temperature occurring subsequently.
* Case No. 24. — Mary M., 14, admitted September 15th. Patient on night prior to admission
became gradually very ill with severe frontal headache. On daj^ of admission, sickness and vomiting
were the most prominent symptoms, but she also complained of a tender swelling in her left axilla.
On admission, the temperature was 99"8, the pulse was 120, and the respirations were 28. The face
was of an earthy colour, with an anxious look ; the lips were dry and the skin was hot to the touch.
The tongue was dry over the dorsum, but the edges were red and moist. There was no rash. Four
inches from the base of the axilla there was a single small, hard, tender gland, which was freely
moveable ; at the border of the latissimus dorsi Ijehind there was another gland rather more
obvious, but not so tender. No other complaints were made at the time of admission. No serum
was given, as the patient did not appear particularly ill. Next evening, the temperature had risen to
101 "4. It was then noticed, for the . first time, that the patient had on the back, about the level of
the spine of the eighth dorsal vertibra, a small pustule. This pustule showed certain distinctive
features. It was about a quarter of an inch in diameter, the centre being depressed and covered
by a scab, while the edge was raised, and formed of a ring of minute pustules. An inflammatory
zone of about 2i inches surrounded this pustule. Direct microscopical examination of the material
obtained from tlie pustule showed the presence of numerous quite characteristic plague bacilli, whilst
in many of the leucocytes degenerating forms of the same organism were apparent. Cultures were
made, and a characteristic growth of the organism obtained. 20 cubic centimetres of serum was
injected subcutaneously. Next day, 17th September, the temperature had fallen to normal, and
the patient was somewhat better; but, although the gland in the axilla was a little less tender, the
pustule showed no signs of diminishing. In the evening another area of congestion appeared on the
left flank. The following morning the patient's temperature was 102°, and she was apparently
considerably worse. The second area of inflamed skin had now a j'ellowish centre, as if of commencing
pustulation. At mid-day, 20 cubic centimetres of serum were injected into the right median basilic.
In the evening the patient spontaneously expressed herself very much better, and her temperature was
normal. Next day, 19th September, the patient felt very well. The slough in the centre of the
pustule had separated, leaving a healthy granulating surface, and the second erythematous area in
the flank had almost completely disappeared. From this point convalescence was uninterrupted.
(Photograph to illustrate site of pustule and bubo, Plate VI.).
* Case No. 25. — Pi. M., set. 12, admitted 16th September, 1900. — Patient became ill on the evening
of 14th September with slight headache. Next morning he was much prostrated, and the headaclje
had become very severe. He also made complaint of acute pain in the left axilla, and this seems
to have been from that time up to his admission to hospital his most clamant symptom. No history
of rigor, sickness, or vomiting could be obtained. On admission his temperature was 102-4*,
the pulse numbered 130, and the respirations 36. The patient looked very ill. The face had the
characteristic ashy pallor, with drawn brows. The lips were dry and fissured ; the tongue dry
and brown on the dorsum, but moist and red at the edges. The ej'es .were clear, and the
conjunctivae not injected. There was some mental obscuration, dependent partly on the grave
prostration, but partly also on his continual dread of the pain consequent on his being even carefully
handled. The slightest movement caused the most acute pain, referred chiefly to the left axilla.
Palpation in this region revealed the presence of a small indurated gland, which was very tender.
Unlike, however, what had been observed in other cases, the tenderness was not limited to the
immediate neighbourhood of this bubi, but extended to the outer portion of the pectoral region.
Physical examination of the lungs revealed nothing noteworthy beyond a few localised patches
of crepitant lale. There was no dyspncea, and no evidence of pulmonary engorgement. The heart's
52
action was very feeble, and the apex impulse widely diffused. The pulse was full and bounding, but
of very poor tension. The spleen was not enlarged. The urine contained no albumen. The bowels were
constipated.
Twenty cubic centimetres of serum were injected subcutaneously, and also 20 cubic centimetres
into the right median cephalic vein on the evening of admission.
On 17th September patient's general condition seemed rather better, the tongue being moister,
and ihe expression of the face less anxious. There was also less tenderness in the left axilla. On the
18th his condition was worse, and an additional dose of 20 cubic centimetres of serum was injected
subcutaneously in the afternoon. On the 19th, 20 cubic centimetres were injected intravenously.
Next day there was no apparent improvement, tlie respirations were more frequent, and an increased
amount of crepitant rale was audible over both lungs. There was, however, no cough, and no
sputum could be obtained. At the outer part of the left pectoral region was an indefinite swelling,
feeling, on palpation, as if situated under the pectoral muscle, suggestive of deep abscess formation.
The axillary bubo was no longer tender. As the temperature since admission seemed to indicate
a pyogenic infection, and as the serum had no effect on its course, no more serum was given, on the
assumption that the patient was now suffering from the effects of a double infection rather than
from plague alone. This supposition was borne out by the alleviation of the pain, and tenderness at
the site of the bubo, and the recent swelling under the pectoral muscle. By the 2oth this swelling
gave definite signs of deep fluctuation, and was incised after freezing the skin, giving exit to a
sero-purulent fluid, which, on cultivation, gave a pure culture of the staphylococcus aureus, but no
B. pestis was isolated. The abscess was found to be situated under the pectoralis minor. From this
time patient's condition became rapidly worse, and he died on September 28th. The respiration was
very rapid, but patient was so ill that he was not disturbed by physical examination.
Throughout the urine remained free from albumen, except on the 22nd and 23rd September,
when the specimens obtained showed a faint trace.
Post-mortem Examination, S9th September, 1900, by Professor Pertik,
Buda-Pesth.
External A ppearances. — The body is that of an ill nourished child. The bones are poorly developed
and there is great emaciation. The skin is shrivelled ; on the back are numerous medmm-sized livid
yoat-mortem stains. In the left mammillary line in the second intercostal space is a drain opening of
about 6 mm. in diameter. A probe can be easily introduced towards the axilla through this opening,
which traverses both the pectoralis major and minor. The opposed surfaces of both muscles are
brawny and infiltrated with pus. Under the pectoralis minor is a mass, 5 cm. long, 10 cm. broad, and
2 cm. thick, which reaches into the left axilla, and consists of lymphatic glands and connective tissue,
semi-fluid, and infiltrated with pus. The former (lymph glands) are partly softened, and of a
yellowish-grey colour, and partly of a firmer consistence, showing within smooth, slightly granular
cut surfaces, dull areas of coagulation necrosis.- The latter (connective tissue) is of the consistence of
thick cream, infiltrated with pus, mixed with detritus, fat globules, and puriform masses. In parts of
the muscles — the pectoralis minor and the serratus auticus major — there are purulent areas running
parallel with the muscular films.
Position of Organs. — The diaphragm reaches on the right side to the inner border of the fifth, and
on the left to the upper border of the sixth rib. The liver in the middle line reaches 10 cm. under the
xyphoid process, and in the right mammillary line reaches 5 cm. below the costal margin. The
intescines are moderately distended with gas. The lower end of the ileum is contracted. In the
abdominal cavity, in Douglas' pouch, there is about 60 cc. of clear wine-red fluid.
Exaviination of Organs. — On removing the sternum there escapes about 30 co. of thin yellow pus
from the upper end of the anterior mediastinum. This pus evidently comes from the thymus gland,
which has been cut into, and evidently consists of an abscess with a thin wall. The gland itself is
about 7 cm. long, and about 2'8 cm. in thickness at the base.
Lungs. — The anterior edges of the lungs are considerably congested, and adherent to the chest
wall, especially on the right side. The right lung is very large, as in the state of deep inspiration.
On superficial examination there are seen several sub-pleural nodules, free from air, and of a pale
yellowish-red colour, about the size of hazel nuts. These appear above the level of the crepitant
depressed lung substance. The middle lobe is enlarged and non-crepitant, of liver-like consistence.
The cut surface shows many areas of a reddish-grey colour, tough, non-crepitant, and exuding fluid.
After scraping with a knife the surface appears finely granular, and allows the lobular structure of
the middle lobe to be clearly recognised. At the cut surface of the upper and lower lobes the
hypereemic lung tissue, which liere exudes much frothy fluid, and is also in parts atelectatic, appears
depressed, and within that tissue are prominent areas about the size of a hazel nut, which show the
characteristics of disseminated lobular pneumonia. In the lower lobe some of these areas reach the
size of a walnut. In the left lung are about twenty similar nodules of lobular infiltration, which in
the lower lobe, and more especially at the hinder and lower edge, are wedge shaped. The bronchial
glands are greatly enlarged ; they are pale, and at the cut surfaces show a few opaque spots.
The thyroid gland is small, and of a pale reddish -brown colour, with a finelj' granular surface.
The larynx and trachea have the mucous membrane congested, and covered with a reddish-yellow
frothy secretion.
The Heart. — In the pericardium are about 20 cc. of a finely flocculent clear serum. The right
heart is in complete diastole, the left in moderate sj^stole. The apex of the heart is formed by the
left ventricle— the size about that of a child's tist. In the heart there is soft dark-red clot and fluid
blood. The myocardium is very friable and opaque looking, "cloudy swelling." The substance-
53
is pale yellowish-brown in colour. These characters are especially well marked in the papillary
muscles. The valves are patent.
The spleen is enlarged 8 cm. long, 3'5 broad, and 2-5 thick. The capsule is thin and stretched.
The cut surface is smooth. The pulp is not easily removed from the stroma. The malpighian bouiea
are enlarged and hyperffimic, of a dark-brown colour, perhaps also hajmorrhagic.
The suprarenals are of medium size ; the substance is somewhat injected.
The kidneys are of medium size. The cortical substance is friable, opaque, and without obvious"
fatty change. The cut surface projects a little beyond the medulla. It is of a pale reddish-yellow
colour. The medulla is congested, and its cut surface is slightlj^ depressed. Tlie bladder is distended
and filled with flocculent yellow urine.
Tlie stomach. — The mvicous membrane is injected. In the neighbourhood of the pylorus are a
few small punctiform hEemorrhages.
The liver is of medium size. The capsule is thin and stretched and smooth. The tissue generally
is friable, and is in a state of " cloudy swelling." Its colour is a pale yellowish-brown.
The inteuiiien have mucous contents. At the lower end of the ileum ai'e three circumscribed
Injected areas. The solitary follicles and mesenteric glands ai-e not enlarged.
The inguinal glands on both sides, and the right axillary glands, are about the size of beans, of a
greyish-yellow colour, with a smooth cut surface and ordinary consistence.
Diagnosis. — Purulent, left-sided, sub-clavicular, and axillary bubo. Polyadenitis. Abscess in the
thymus gland. Lobular pneumonia of both lungs, here and there necrotic. Hyperplasia of the spleen.
Parenchymatous degeneration of the myocardium, liver, and kidneys. (Bubonic Plague with secondary
lobular pneumonia.) Proximate cause of death — parenchymatous degeneration of the heart muscle,
and resulting cardiac failure, with hypersemia and oedema of the lungs.
*Case No. 26. — Mrs. G. , age 24, admitted 19th September. Patient became ill on the day prior
to admission. The initial symptoms were not of great severity, slight headache and a
feeling of general malaise only being complained of. Coincident with these symptoms a tender
swelling was discovered by patient herself in the right groin. It is to be noted, however,
as accounting, perhaps, for the comparative mildness of the onset, that seven days prior to
the commencement of illness she had received a prophylactic injection of 10 c.c. of Yersin's curative
serum. -On admission patient did not look as if she were very ill. Frontal headache of moderate
severity was complained of, and in the right groin, involving the vertical chain of glands, the above-
mentioned swelling, which was about the size of a walnut, was observed. The glands were more or
less adherent to one another, and also to the subjacent tissues, but the overlying skin was freely
moveable and not inflamed. The tongue was moist and clean ; the bowels were constipated. The
illness had interrupted the suckling of a three-months'-old child, and on this account the breasts were
enlarged and tender. The course of the illness, however, was short, lasting in all about five days, and
the only clamant symptom complained of was the frontal headache. The fever was maintained at a
high level for two or three days, ranging between 100° F. and 104° F., but other symptoms were not
present in like severity. The pyrexia might be regarded as due to three factors — 1st, the attack of
plague, probably the most important ; 2nd, the condition of the breasts, which became very large and
tender ; 3rd, serum fever. The maximum temperature occurred on the ninth and tenth days after the
prophylatic injection of serum — i.e., at the period when the pyrexia due to serum usually made its
appearance. On October 4th spontaneous rupture of the bubo took place, and from the discharges
obtained on that day virulent plague bacilli were recovered. From this point onwards convalescence
was rapid and complete.
* Case No. 27. — Mary G., set. 6, admitted September 19th. This,patient, who is the daughter of
Mrs. G., and niece of Charles M'M. (Cases No. 17 and No. 13), became ill on the day prior to
admission with severe prostration and headace.
On admission patient's temperature was 101 -2° F., the pulse was 146, and the respirations were 44.
The aspect was that of a person acutely ill. The face was pale and somewhat cyanotic, the lips dry and
bine. The tongue was dry over the dorsum, but the edges were moist and clean. The child lay in a
semi-comatose state, and did not even recognise her mother, who lay in the next bed. The right
inguinal region was the seat of a swelling about the size of a hen's egg, and on examination this was
seen to consist of a mass of enlarged and tender lymphatic glands. There was also some peri-
glandular infiltration, but no reddening of the skin. Examination of the lungs failed to detect
anything notewortliy.
On the evening of admission intra-venous injection of the curative serum was attempted, but
without success, as the veins were very thin-walled and deeply embedded in a thick layer of adipose
tissue. 20 c.c. of serum were therefore given subcutaneously into the wall of the abdomen.
Next evening the child was rather worse, the temperature somewhat higher, and the pulse softer
and more compressible. A second attempt to inject serum into a vein failed, and accordingly 40 c.c.
of serum were again injected into the wall of tiie abdomen. The following morning the patient's
condition was, if anything, shghtly better, though she was still more or less unconscious. The pulse,
however, was firmer, and the respirations somewhat slower. A third attempt at intra-venous
injection having failed, 40 c.c. of serum were injected for the third time nito the abdominal wall.
In the evening a very marked improvement was observed, the child having regained its natural
colour, and being now quite conscious for the first time. She smilingly recognised her mother. The
improvement, however, was not maintained beyond the following morning. On the evening of the
54
22nd the temperature again rose, and the pulse became very feeble. From this point onwards patient
sank steadily. Death was associated with marked hj'postatio congestion of the lungs, and was directly
due to heart failure. No additional serum was given on account perhaps of undue timidity, for, as bj'
this time, moderately severe constitutional disturbance following on small doses of the serum had
been frequently observed in healthy persons, it was not deemed advisable to persevere with the
treatment.
Case No. 28. — Baby M., born in Hospital, 16th September, at 4.30 a.m. — Though the mother had
a blood infection of B. pestis (v.s.), the placenta showed no macroscopic lesion. At birth the
child was completely asphyxiated, and no spontaneous attempt at respiration was made for almost
three-quarters of an hour.
For eight days the child seemed to be quite well, but on the ninth day it was observed that the
neck seemed rigid, and on examination some induration was discovered on the left side of the neck,
high up, at the posterior border of the sterno mastoid. Next day a few isolated glands could be felt,
about the size of a pea, in the above-mentioned situation, and the group of glands lying in the anterior
triangle of the neck were by this time also affected. On the right side there were also some enlarged
lymphatic glands, but not so large as those on the left side. The temperature, which had previously
not risen above 99 '6°, rose on this evening to 101°. Next day the child refused its food, and vomited
frequently. The child rapidly sank, and died on the following afternoon.
Post-mortem Examination, 27th September, 1900, by Br. R. M. Buchanan.
External Appearances. — The body is that of a well-formed infant of recent birth. There is
lividity of the whole surface. The circumference of the neck is greatly increased by an ill defined
elongated swelling along the line of the hinder border of the sterno-mastoid muscle on each side, and
diffuse swelling of the front and back of the neck.
Chest. — The heart shows very marked parenchymatous degeneration, the muscle having a pale,
granular, parboiled appearance. Its cavities are all occupied by soft very dark coloured blood clots.
The pleural cavities contain opaque yellow fluid. The pleural surface of both lungs, in the lateral
aspect, shows a thin film of fibrinous exudation.
The ler't luri'j appears intensely hyperfemic and partly consolidated. It floats in water. The
pleural surface presents a considerable number of minute hiemorrhagic points, several of which have
a yellowish centre. On section similar hsemorrhagic areas are disposed throughout the substance of
both lobes in the manner of a broncho-pneumonia.
The right lung is rather more consolidated and more hypereemic than the left, and the pleural
surface shows a larger number of minute yellow points with a marginal zone of intense congestion or
haemorrhage. In the lung substance hsemorrhagic lobular consolidations are also more numerous and
more extensive.
Ah iomeii.—'T'he spleen is much enlarged alid of a firm consistence, resembling that of the liver.
Section of the organ displays intense hypertEmia, the cut surfaces being very dark in colour, and
having a homogeneous, glossy appearance.
The liver is enlarged and extremely hypersemic, very dark blood flowing freely from the vessels on
incision. Its substance shows very marked cloudy swelling, and parts of the cut surface are very
pale. A small number of minute yellowish foci, from 1 to 2 mm. in diameter, are distributed
throughout the organ. Those at the surface are not raised, and they are all of firm consistence. The
capsule of Glisson is oedematous.
The kidneys are hypersemic, and the cut surfaces are studded with minute hoemorrhagic foci,
disposed chiefly in the pyramids. The cortical tissue is dull, opaque, and of a brownish-yellow
colour.
The right fupra-i-enal gland is considerably swollen, and median section displays the whole
organ transformed into a dense yellow cheesy looking mass by coagulation necrosis. The left sut ra-
reiial gland is very hypersemic. Its medullary tissue is notably oedematous, the fluid being sanious.
Glands. — There is a general enlargement, with hyperemia of the lymphatic glands. The
mesenteric, inguinal, prevertebral and bronchial glands are all hypersemic and increased in size, while
the axillary and cervical glands have undergone great enlargement.
The axillary glands are in the form of a flattened mass rather larger than an almond, with cedema
and hypersemia of surrounding tissues. On section these glands appear intensely congested, but
no lijemorrhage or necrosis is detected.
On dissecting the tissues of the neck to expose cervical glands a hsemorrhagic oederqa of the
subcutaneous tissue is displayed. The glands behind the sterno-mastoid muscles form a dense
elongated mass on both sides. The glands comprising each mass are seen on section (Fig. 2) to have
attained a size varjdng from an eighth to half-an-inch in diameter. All are intensely engorged and
some are necrosed. The latter are opaque, finely granular, and greyish, or finely mottled,
brownish-red, and grey.
A similar mass of enlarged glands is found on each side of the larynx and trachea, most of the
glands in which present this hremorrhagic granular opaque appearance of necrosis.
The occipital tissues are oedematous, and the occipital glands partake in the general enlargement,
without necrosis.
The Thymus gland, the larynx, and the trachea are hypersemic.
The stomach presents a few small slightly hypersemic patches. The intestines are normal.
Case D. — Mrs. G., aet. 55, admitted September 1st. — Patient was ^mitted in a comatose
condition from which she could not be roused. No definite liistory could be obtained, but the
illness probably dated from August 21. On admission the temperature was 102''2, the pulse 104, and
the respiration 36. The tongue was dry and browu and the gums covered with scales. The
expression was that of stupor. The eyes were injected and the pupils contracted. The skin was
covered with a mottling resembling that of typhus. The heart's sounds were very weak and the
lungs showed signs of marked hypostatic congestion. lu the left groin, above Poupart's ligament,
was a sausage-shaped swelling, evidently consisting of enlarged lymphatic glands, not, however,
tender. She remained comatose, sank gradually, and died on September 4th.
Post-mortem Examinat ion, 4th Se2)tember, 1900, by Br. R. M. Buchanan.
External appearance^. — The skin generally is dusky, and the surface of the abdomen is marked
by a faint typhus-like mottling ; numerous petechire are visible over the abdomen and thighs.
Ciiefit. — The heart is soft and flabby, the muscular tissue appearing pale brown on section. The
cusps of the aortic and pulmonary valves are slightly thickened and fenestrated.
The riijht lung is firmly adherent all over. It is hypersemic and oedematous posteriorly, and the
lower lobe shows some condensation in indefinite areas.
The left lung is hyperffimic and oedematous.
Abdomen. — The spleen is soft and diffluent. The livr shows some cloudy swelling. The kidneys
are also marked by cloudy swelling, and present a granular surface on removal of the capsule.
Glands. — The glands in the left groin are much enlarged, and surrounded by oedematous tissue.
The glands involved in the enlargement lie along Poupart's ligament. On section they all have the
appearance of well-defiued abscesses, containing shreds of necrosed tissue and brownish viscid pus, and
delimited by a thin rind of residual gland tissue infiltrated with blood. They have all attained a
a fairly uniform diameter of about three quarters of an inch.
The same set of glands in the right inguinal region is also enlarged, but to a lesser fextent. The
largest of the group being less than half-an-inch in diameter, and being the only one which displays
suppuration.
The prevertthral glands, especially on the left side, are hyperiemic and slightly swollen.
The glands in the other parts appear normal.
Clinical History of a Pneumoma (? Plague).
* Case X.— A. A., set. 18, admitted 6th September, 1900. — Patient was apparently in full
liealth on the morning of 1st September, but during the course of the evening he complained
of slight headache. From this point onwards he evidently felt somewhat out of sorts, but
was able to continue at work till 4th September, and was even present at a dance the same
evening. Early on the morning of the 5th, however, he became acutely ill with pain in the
right side. The symptoms of illness appeared to have developed with great rapidity, and on the
evening of the 6th he was admitted to the Western Infirmary. His appearance there being regarded
with suspicion, the physician in charge deemed it advisai)le to have him transferred to P)elvidere the
same evening. On admission patient was evidently acutely ill. The admission temperature was
99 8 F., but this was evidently due to collapse, as the record prior to removal from the Western
Infirmary was 104 F. ). The pulse numbered 124 per minute and was soft and full. The respirations
were 42, but there was no evidence of any respiratory distress. The face generally was of an ashy-
grey colour, with a dusky flush in the malar regions. The eyes were held widely open, the conjunc-
tivee injected, and the pupils dilated. The tongue was moist and covered with a white fur. The
skin showed, especially on the trunk, a general erythematous mottling, resembling that already noted
in plague. This was also preseut on the extensor surfaces of the forearms, though to a less extent.
Examination of the lymphatic glandular system revealed slight enlargement of the glands in the right
axilla and also of those in the left groin. No special tenderness, however, was complained of on
manipulation. Physical examination of the lungs revealed slight relative dulness to percussion over
the left back from the spine of the scapula downwards. The breath sounds over this area were
distinctly tubular, and the vocal resonance and vocal fi'emitus were both exaggerated. Next day
patient's condition was much the same, the evening temperature being 105 F. He was drowsy, how-
ever, and had some sligiit muttering delirium, but made no complaint of pain. The expectoration,
which was very scanty and viscous, was slightly tinged with blood. On direct microscopical
examination of the sputum, large numbers of diplococci were seen, and there was also present in very
considerable numbers a bi-polar stainiug bacillus, which was decolourised by Gram's method, and
morphologically was indistinguishable from that of plague. In many parts of the slide this bacillus
appeared to be present in almost pure culture.
Examination of the chest on 8th September showed, in addition to the signs already enumerated,
a certain amount of fine subcrepitant rale accompanying the inspiratory murmhr in the consolidattd
area. Over the lower lobe of the right lung also a variable amount of rather fine bronchial rale was
heard. The upper part of both lungs yielded a perfectly clear percussion note whilst the respiratory
murmur in this situation was entirely devoid of rale. The temperature did not reach normal till 12th
September, and terminated, not by a true crisis, but by a somewhat rapid lysis extending over 48
hours. This lysis resembled the lysis of plague rather than that of pneumonia, and was unaccompanied
by sweating, the skin remaiuing dry to the touch. Convaleaceuce was rapid and uninterrupted.
56
Unfortunately the sputum was not inoculated directly into an animal, and on account of an
accident to the regulator of the incubator, the only culture of the above-mentioned plague-resembling
bacillus was destroyed at a time when it was no longer possible to obtain another. The definite
diagnosis of this case therefore remained to a certain extent doubtful. During convalescence, how-
ever, a very pronounced agglutinative reaction was obtained from the blood in a dilution of 1-25.
It may here be remarked that, as making for the diagnosis of plague pneumonia, the serum of this
patient taken during late convalescence exhibited decided prophylactic qualities. This was
demonstrated by the following experiment performed by Dr. Cairns. Two white mice, A and B, of
approximately equal weight, were each inoculated with a lethal dose of an active and virulent culture
of plague bacilli. In the case of B, however, | c.c. of blood serum, taken from the patient during the
ninth week of illness was injected into the subcutaneous tissues of the back twenty-four hours before
performing the inoculation. The following results were observed : — Control animal A became obviously
very ill 12 hours after inoculation, and died at the end of twenty -four hours. Post-mortem examination
showed the spleen to be slightly enlarged and engorged with free plague bacilli, none of which were
enclosed by the splenic cells. The organisms were also present in the blood in very large numbers.
Animal B never appeared to be particularly ill at any time, but died suddenly on the twelfth day
after injection. Post-mortem examination showed the spleen to be slightly enlarged, and on
examining smear preparations of splenic juice only a few free bacilli could be found after a prolonged
search. The splenic cells, however, contained plague bacilli in all stages of digestion.
CHARTS, SHOWING TEMPER ATU RE , WITH PULSE AND RESPIRATION RATES,
OF THE MORE INTERESTING CASES (with references).
August JilQO Septcmi/er
August WOO
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57
CLINICAL BACTERIOLOGY.
By J. Campbell M'Cluee, M.B.(Glas.),
Senior Res. Assist. Physician, Belvidere Hospital.
In almost all the cases admitted to Belvidere a bacteriological examination
of the bubo was attempted on admission, with varying result, according to the length
of time the patient had been suffering from plague and the situation of the bubo,
it being sometimes impossible in the mild cases to puncture a small deeply-
situated gland.
The method of examination was as follows :— The skin over the bubo was
rendered sterile; the bubo was punctured with a sterilised hy]Dodermic needle,
some fluid drawn off by the syringe, and cover-glass preparations and inoculations
on agar and glycerine-agar made from the contents.
In all cases of true plague, where the bubo was examined during the first
week of illness, the B. pestis was easily recovered. Direct microscopical examina-
tion of the fluid withdrawn usually showed the characteristic bi-polar staining
bacillus, but often only in very small numbers, even in the most malignant cases.
With one exception (case of P.M., No. 7) the cultures made on agar from the same
fluid yielded on incubation pure cultures of the B. pestis. In the exception referred
to a large diplococcus was also present in considerable numbers. The bacteriological
examination of the bubo was usually negative at the end of the second week ; in some
of the milder cases, indeed, the bacillus had disappeared by the seventh day; but in two
cases (P.F. and J. B., Nos. 3 and 1) the B. pestis was recovered from the bubo eighteen
days after the commencement of the illness. This was the latest date in the
illness at which the bacillus was recovered from the bubo. While cultures made from
the bubo after the second week, as mentioned above, were almost invariably sterile
direct microscopical examination showed with great constancy for some days after
it was impossible to cultivate the bacillus the presence of certain degenerate
bacillary forms, such as our experience had taught us to associate with degenerating
plague bacilli. These degenerate forms were found both free in the fluid, and also
contained in cells.
In only one instance was the bacillus recovered from an external lesion, and
on that occasion (case of M.M., No. 24) it was easily recovered from a small pustule
in the back. This appears to have been the original point of inoculation.
After the spontaneous rupture of a bubo the chances of recovering the bacillus
are apparently very remote ; in only one case (Mrs. G., No. 26) was the examination
positive. Here typical forms of the B. pestis were seen on direct microscopical
examination, and proved to be actively virulent when inoculated directly into
animals.
In several instances inflammatory conditions occurred during convalescence,
which, from analogy with other infectious fevers, might reasonably have been
supposed to be due to metastatic infection by the B. pestis, but repeated examina-
tion failed to reveal the presence of the specific organism. Of these instances may
be mentioned the case of Mrs. T. (No. 2), who developed an acute otitis media, and
that of P.F., who developed an acute conjunctivitis. In the former of these cases
only the B. pyocyaneus and a diplococcus were found in the aural discharge, and in
the latter the conjunctival sac yielded only the staphylococcus pyogenes aureus and
albus, a large diplococcus, and the so-called pseudo-diphtheria bacillus of the eye.
On account of the importance, from a public health point of view, of the
investigation of possible sources of infection, the urine was systematically examined,
both during the acute stages of the disease and also during convalescence, although
much more thoroughly in the latter. In no instance was the B. pestis recovered,
the urine even of R.M. (No. 25), an example of the septicfemic tyjie of the
disease, from whom characteristic organisms were found widespread after death,
proving sterile, both by culture and by the direct inoculation into mice and guinea-
pigs of the sediment obtained by centrifugalisation.
58
In one case post-mortem examination showed that although the B. pestis had
apparently disappeared from the bubo, it still maintained its existence in the body
in a virulent condition. In this case (J.B. No. 1) the bacillus was recovered after
death from the spleen and liver, although the date of death was in both cases
some six weeks after the onset of the illness, and although the bubo yielded no
culture-growths of the specific organism.
The preceding remarks apply to all cases of plague observed here without
distinction, but some special remarks fall to be made with regard to double
infections and the fatal cases.
The result of bacteriological examination in the latter group of cases is given
in the accompanying table.
The cases where double infection was observed fall naturally into two classes —
(1) where the double infection seemed to be primary, ■i.e., where there was no visible
external lesion ; and (2) where a pyogenic infection seemed to follow the rupture of
a bubo.
Glass I. — All the cases in this class were fatal —
(a) " P.M." (No. 7). — This patient died of the septicsemic variety of plague. The only organism
present beside the B. pestis was a diplococcus discovered in the bubo.
(b) "G. H." (No. 18). — This patient lived only a few hours after coming to hospital, and in all
his organs after death were found both the B. pestis and the streptococcus pyogenes, the latter far
exceeding the former in numbers. A diplococcus was also present in the bubo.
(c) " R. M."(No. 25). — This patient's bubo was not examined on admission, as he was very ill, and
there was no doubt of the diagnosis either clinically or from association. On the ninth day of illness,
as it was evident that an abscess had formed in connection with the axillary bubo, incision was made
and agar tubes inoculated from the pus. The cultures yielded only colonies of the staphylococcus
pyogenes aureus. Cultures made from the blood during life were invariably sterile. On post-viortem
examination, however, the B. pestis and the staphylococcus pyogenes aureus were recovered not
only from the bubo, but also from the heart's blood and the principal viscera. The urine and
peritoneal fluid were sterile.
(d) " Mrs. M." (No. 22). — lu this patient puncture of the bubo and examination of the blood during
life, and cultures m&d.p, post mortem from bubo, heart's blood, spleen, lungs, liver, and retro- peritoneal
glands, showed the presence of B. pestis, contaminated only by B. coli communis in the abdominal
organs and by diplococci in the lungs. The presence of a diplococcus in the retro -peritoneal glands
was, however, demonstrated in section after staining by Gram's method. This patient must, there-
fore, be included in the group of primary double infections in plague.
Class II. — To this class belong four cases, in all of which secondary infection
seemed to be associated with sloughing of the buboes, as the latter all gave only
pure cultures of the B. pestis prior to the beginning of necrosis.
(a) " Mrs. T." (No. 2). — After rupture of the bubo the staphylococcus pyogenes aureus was found
in the discharges during the secondary fever, and in an acute otitis media occurring during convales-
cence the B. pyocyaneus and a diplococcus were obtained in culture from the aural discharge. This
patient recovered.
(6) "P.F." (No. 3). — Admitted on the fifteenth day of illness. Crisis on the eighteenth day was
followed by sixteen days of intermittent pyrexia. Examination of the bubo on admission showed the
presence of the B. pestis and no other organism, both on direct examination and from culture.
Sloughing of the biibo took place on the twenty-third day of illness, and from the discharge the
staphylococcus aureus and albus witii a small putrefactive bacillus were obtained, but no B. pestis,
even ou direct microscopical examination.
(c) "J.B." (No. 1). — In this case a prolonged secondary fever preceded death, and after death
cultures made from the bubo yielded luxuriant growths of a small putrefactive bacillus, from the
midst of which the B. pestis was recovered with great difficulty. In the spleen the B. pestis was
likewise scanty, and was associated with large numbers of the staphylococcus pyogenes albus.
Two cases (B.M., No. 28, and M.G., No. 27) terminated fatally, in which death
seemed to occur from a pure infection of the B. pestis. In the latter case a 2)ost-
mortem examination was refused, while in the former no other organism was
recovered after death save only the B. coli communis, which can scarcely be
regarded as a double infection, seeing that it is almost constantly met with in
cultivations made from the cadaver.
As mentioned above, it was almost impossible in the extremely mild cases of
plague to puncture the affected glands, on account of their small size and
frequently deep situation. In one case, that of the wardmaid (E.R, No. 21), where
the glands affected were, although small, in the occipital region, and therefore
easily accessible, puncture showed the presence of the B. pestis in pure culture.
59
THE SEROTHERAPEUTICS OF PLAGUE.
By John Brownlee, M.A., M.D.(Glasg.), D.P.H.(Camb.).
In giving an account of my experience of the treatment of patients suffering
from plague with Yersin's serum, as received from the Pasteur Institute of Paris,
it may be well to point out that the disease, as it occurred in Glasgow, was
apparently of a much milder type than that usually seen in the East The
number of cases was too small to admit of statistical comparison between those
treated with the serum and those not so treated, and, on account of the mild
character of the epidemic, comparison with the statistics of other epidemics in other
countries is not possible. Consequently the value of the treatment can only be
gauged by a careful consideration of each case in detail.
The first two cases in which the serum was given were those of T. H. and
C. M. (Cases No. 9 and 19). In both these cases the only organism obtained
in puncturing the buboes was the bacillus pestis. The first of these cases belonged
to the septicsemic variety of plague, with multiple bubo. The prognosis was bad.
Within 36 hours of the administration of the serum the temperature nearly fell
to normal, and the patient was apparently out of danger. In the second case,
which appeared to be an example of the fulminant type of plague, an injection
of 20 c.c. of the serum intravenously, and of a like amount sub-cutaneously,
was followed within 24 hours by a complete cessation of symptoms. Both
patients were excessively ill, and in both the subsidence of the symptoms was
marked and immediate. There were, it is true, some cases of plague untreated
by the serum in which thei-e was a critical fall in the temperature ; but in these
the disappearance of the mental obscuration which accompanied the fever was
much more gradual, and the convalescence more tedious. In both the cases under
consideration, a symptom was present not observed in any of the other cases which
terminated by crisis, viz., a few hours after the injection a copious sweating
occurred over the whole body.
The next three persons treated by serum suffered from a milder type of the
disease; in only one was the prognosis doubtful. The first, Mrs. B., No. 20, was a case
with right inguinal bubo, from which, on puncture, a pure culture of bacillus
pestis was obtained. The patient on admission did not seem sufficiently ill to
require an injection of the serum, but two days later, as the symptoms had con-
siderably advanced, 20 c.c. of the serum were injected subcutaneously into the
abdominal wall. The next day the symptoms had somewhat abated. The jmin in
the bubo was less, and the reddening of the skin over the swelling was not so marlfed.
In the evening, however, the patient's condition was again not so good, and by the
following morning the temperature had again risen. The local condition had
advanced, and the infectious process had extended so as to involve the lymphatic
glands above Poupart's ligament, and also the deep inguinal glands. A further
injection of 20 c.c. of the serum was then given, this tune into one of the veins of the
right arm. An immediate improvement was noted Six hours after the administra-
tion of the serum the temperature had become normal, and on this occasion no
subsequent rise took place such as had occurred after the former dose administered
subcutaneously. In a second instance the result was equally interesting. The
case was that of M. M., No. 24. This patient, a girl of 14 years of age, suffered
from a bubo in the left axilla. The point of entry of the infection Avas evidently
located in the back, where, as described in the full report, a small pustule was
situated, which was proved bacteriologically to contain the plague bacillus. The
external local condition afforded a visible index by which the therapeutic effect of
the remedy could be gauged. Here again a subcutaneous injection of the serum
was followed by a temporary improvement as regards the bubo, the pain being con-
60
siderably less on the next day, but no improvement could be seen in the pustule
above-mentioned. A recrudescence of the disease occurred likewise in this case,
with a rise of temperature to 102° F. A second pustule began to form on the back,
while the erythematous zone surrounding the first-occurring pustule became rather
larger. Here again the intravenous injection of the serum in a dose of 20 c.c. was
followed by an immediate improvement. Within 24 hours a slough in the centre
of the original pustule had separated, and the inflammatory zone had almost dis-
appeared, while the second commencing pustule had completely aborted. The
patient six hours after the administration of the last dose of serum spontaneously
expressed herself as feeling very much better. The temperature by the same time
had fallen to normal, and, as in the other case just mentioned, it remained so without
subsequent rise. Convalescence from this point was rapid and uninterrupted. The
third case belonging to this group was that of Mrs. M., No. 23. This patient, the
mother of the preceding, was aged 41. She had a right inguinal bubo. On
admission the temperature was 102°'4 F., the pulse was 104, and the respirations
were 2 k The patient was evidently ill, though a fatal issue was not expected. A
subcutaneous injection of 20c.c. of the serum produced almost no effect, but there
was, if anything, next day a lessening of the pain in the bubo. Thirty-six hours
later a second injection of 20c.c. was given intra- venously. As in the other two cases
just noted, there was observed an almost immediate improvement, the patient
expressing herself as being much better six hours after the remedy had been
administered. The temperature fell to normal within 24 hours, and remained there.
The points to be noted with regard to all these are, that the subcutaneous
injection of the remedy produced little effect, and that of a temporary nature,
while the administration of the serum intravenously was followed in each case by
an improvement which was easily seen in the subsidence of the signs of illness, and
which, besides, was spontaneously borne witness to by the patients themselves.
The serum was also administered to four persons in whom the disease pro-
gressed to a fatal issue. One of these needs no mention, as he did not come
under treatment till the fourth week of the illness, at which period an extensive
secondary pyogenic infection of the sloughing bubo had occurred. Each of the
other three require special note. The first of these in point of time was Mrs.
M., case No. 22). She had for some time prior to the onset of illness
experienced considerable privation. On admission she was extremely ill, and
premature labour was in progress. No apparent benefit resulted from the
administration of the remedy, the patient dying within about three days
from the commencement of the illness. In this case serum was administered
on the evening of admission — 20 c.c. into a vein of the right arm and 20 c.c.
into the subcutaneous tissue of the flexure surface of the left thigh, so
that it might drain directly into the bubo, which was situated in the left groin.
Next day 20 c.c. additional was administered into the subcutaneous tissues of
the abdomen. Though only the plague bacillus was obtained on culture from
the bubo in this case both before and after death, yet in the retroperitoneal
glands it was demonstrated that the infection was a mixed one, as considerable
numbers of colonies of a dipplococcus, staining by Gram's method, were seen on
section of these. This patient was so enfeebled by the privation which she had
undergone that she would in all probability not have survived her confinement, apart
from the attack of plague. So that, both because the case was not uncomplicated,
and because of the patient's weakness, the result cannot be said to weigh one way or
the other in appraising the value of the serum treatment. But it must be noted, as
indicating that the serum had some considerable influence on the organism, that the
bubo revealed, on examination after death, no plague bacillary forms which did not
bear evidence of the most profound degeneration, while those obtained from the
other organs of the body, showed no evidence of being in any way altered. On the
same day the brother of this patient was admitted (R.M., Case No. 25). Here also
the infection was from the first of a mixed nature. When in the course of the
61
.second week of illness one of the buboes had proceeded to abscess, the only organism
recovered from the discharge after incision was the staph, pyog. aureus, and that in
great numbers. As there were no means of infection of this bubo prior to its
incision, it is highly probable, considering the septic course of the temperature,
that the double infection was primary. Of all the cases treated with the serum at
the beginning of the illness this is the only one in which no effect of any kind was
noted.
The only other case in which the serum was administered was that of M. G.
(Case No. 27). This was, though fatal, one of the most interesting in some of its
features. The patient was a child six years old. Puncture of the bubo in the
right groin on admission resulted in the discovery of the plague bacillus in its
typical forms. On admission she was profoundly ill, and in a state of almost com-
plete unconsciousness. When disturbed she cried out harshly and struggled to be
let alone, but otherwise took no notice of her environment. As recorded in the
reporc, intravenous injection was attempted without success, but in the first 48
hours after admission she received 100 c.c. of the serum into the subcutaneous
tissues, chiefly of the lower part of the abdomen. On the morning of the fourth
day after admission a marked improvement was noted, in so much that the child
for the first time recognised her mother, and smiled to her. From this point,
however, there was a rapid advance in the gravity of the case, and death supervened,
with the usual symptoms of heart failure, on the eighth day of illness. The same
appearance was noted in this case as in that of Mrs. M. (Case No. 22) above
referred to, namely, that the bacilli found in the bubo which received the strain of
a large part of the serum administered, was marked by degeneration, while those in
the deeper organs of the body were unaffected and very virulent.
A general review of the action of Yersin's serum falls to be considered under
two heads — First, by the prophylactic action ; and second, by the curative action.
1. The Protective Action of the Anti-plague Serum. — Of the healthy persons
who had been in contact with plague, and who received a prophylactic injection of
the anti-plague serum, two developed the disease. One of these was a maid
attached to the service of the plague wards. From her buboes the specific bacillus
of plague was recovered, and at the appropriate time after the disease was over, her
blood gave the typical agglutinative reaction in a marked degree. The other was
the mother of one of the fatal cases noted above (Mrs. G., Case No. 26). The
latter during the course of the disease ran a fairly high pyrexia, but she never gave
the impression that she was dangerously ill. The three factors which might have
contributed to produce this high temperature are noted in the full report.
These two cases prove that a dose of 10 c.c. of Yersin's serum administered subcu-
taneously does not afford complete protection, yet it is a fair presumption that a
certain degree of immunity is afforded, as the syinptoms in both cases were of great
mildness. This corresponds with what has been frequently observed with regard
to the action of diphtheria anti-toxin when used as a prophylactic. Immunity is
not a certainty, but if the disease becomes established the attack is almost certain
to be slight.
No. 2. Curative Action. — A general review of the facts given above, and a
consideration of the reports of the individual cases, will, I think, justify the
following conclusions : — Firstly, that subcutaneous injection is not of any great
curative value. This is probably not due to the blocking of the lymphatics during
an attack of plague, as has been suggested by some, in view of the fact that
absorption of the serum by healthy persons is no more rapid than that seen in
the plague patients. The failure in action is therefore much more likely the
result of the lymphatic system exercising a distinct action as a biological filter
on the serum, such as exists in the organs. In this way the antitoxic substances of
the serum are retained largely in the glands which drain the area into which the
injection is given, so that only the more inert portions of the serum reach the
general circulation. It was noticed that the lymphatic glands connected with the
area into which the injection was made in healthy persons enlarged for some days
thereafter. This is not a proof that such a filtering action as above indicated takes
place, yet it shows that some constituent of the serum having an irritant action is
retained, and, if the glands possess the power of filtering out certain ingredients of
the serum, there is no reason to doubt, in the light of what has gone before, that
this may include the active anti-toxin. The case of Mrs. M. (Case No. 22) lends some
clinical supj^ort to this view. The inguinal bubo, into the drainage area of which
the serum had been injected, showed post-mortem evidence of a potent local effect
in the marked degeneration of the bacilli, while the organisms found in other parts
of the body were quite normal. It is therefore evident that subcutaneous injection
of the serum can be efficient only in cases where the infection is localised to a bubo
and has not become general. Secondly, the intravenous injection of the serum
seems, in most cases, to produce a most marked therapeutic effect, even when
given late in the disease. This is exemplified in the case of T. H. (Case No. 9),
where it was administered on the eleventh day of illness. In those cases,
however, where double infection has existed from the beginning its action is greatly
lessened.
In conclusion, it is probable that the doses given were, in general, too small -
and should an opportunity again arise of using this remedy, large initial doses of
60 c.c. and upwards would be given intravenously. Probably it would be advisable,
if using the serum subcutaneously at all, to inject it only into the area drained by
the lymphatic system which leads directly to the bubo.
ON THE AGGLUTINATING PROPERTY OF BLOOD SERUM IN CASES OF PLAGUE.
By D. Louis Caibns, M.B.(Glasg.),
Resident Assistant Physician, City of Glasgow Fever Hospital, Belvidere.
Q'he number of observations which have been made up to this time on the aggluticative power of
serum from patients in the course of, or during convalescence from, an attack of bubonic plague is
comparatively limited. This is all the more remarkable when one considers the numerous opportunities
which have occurred during the last five or six years for such observations. The literature also bearing
on the subject is not at present of such extent or completeness as to furnish a basis for inferences of
practical value. The earliest reference to this part of the subject which I have been able to find is
contained in the report of the German Commission sent to Bombay for the investigation of plague.
In their abstracted report, published in the Deutsche Medici n.ische Wochenachrift for 1897, the existence
is announced of a definite reaction between the serum of man and animals infected with plague and an
emulsion of the specific bacillus. The reaction consists in the precipitation of the bacilli in the form
of small distinct fioccules when such serum is added to a test tube containing an emulsion of plague
bacilli. The report also states that no such precipitation of other organisms by plague serum occurs,
the emulsion of these remaining uniformly turbid. The report of the Commission, however, makes no
mention of the value of the reaction either as a diagnostic or prognostic agent in this disease, and
suggests merely that the specificity of the reaction may constitute a reliable method for the iden-
tification of the plague bacillus and its differentiation from other organisms closely resembling it.
Ab.)ut the same time Paltauf^ established the existence of the reaction in the blood of animals (guinea
pigs and horses) which had succumbed to inoculations of dead plague cultures. A very slight degree
of dilutiim of the blood, however (from 1 to 5 or even 1 to 1), was employed — a fact which tends to
diminish the value of the observations. Considerably greater practical importance attaches to the
results obtained by Wyssokowitz and Zabolotny. - These authors state that the agglutinative power
is not manifest during the earliest and most acute stage of the disease. It first appears in the blood
about the sevsnth day of illness, gradually increases up till the fourth week, and declines after this
period. In cases fatal during the first week of illness they found it absent.
A short r4mm4 of the results obtained independently by Professor Zabolotny during the epidemic
at Bombay in 1897 appeared in ihe Deutsche Medicinische Wochenschrifi for the same year,^and though
■ Wiener Klinische Wothenschiift, 1897, p. 637 ; also La Semaine M^dicale, June 2n(i, 1897.
» Archives Kusscs de Pathologie, May, 1897. Recherches sur la Pestc Bubonique, Annales de I'lnstitut Pasteur, No. 8,
p. 663, 1897.
2 Uber agglutigirende Eigenschaf ten dcs llensthenblutserums bei der Pest, Deutsche Medicinische Wochenschrifi, 189:,
No. 24, p. 39l'.
63
no details are given the conclusions to which he has been led substantially a^ee with those of the last-
mentioned observers. In a subsequent paper^ the method employed for demonstrating the reaction is
stated, and from a comparatively large number of single observations the probable curve of the agglu-
tination wave is constructed. I desire here to acknowledge my indebtedness to Professor Zabolotny,
to whom, during his stay in Glasgow, I owed several valuable suggestions in the carrying out of my
work on this subject. Dr. Leumann, of the Bombay Plague Laboratory, has also made a considerable
number of single observations on the bactericidal and agglutinative properties of plague serum, and
while the technique adopted was sufficient for the demonstration of the former property and for rough
estimations of the latter, it was evidently quite impossible to obtain reliable comparative data by this
method. One or two loopfuls of an agar culture were simply suspended in sterile water and serum
was added drop by drop till precipitation of the microbes occurred. No attempt was made to estimate
the relative proportions of seium and emulsion, and, as will be shown later, the sine qua non of all
agglutinative experiments — viz., a perfectly homogeneous emulsion — cannot be obtained by this
method. A short paper by Dr. E. Klein- completes the list of those which I have hitherto been able
to consult. In it he mentions the difficulty and empha.?ises the importance of obtaining a perfectly
homogeneous distribution of the bacilli in the emulsion to be used, (This is referred to in a later part
of the present paper.) The extensive report of the Austrian Commission contains, so far as I am
aware, no reference to this aspect of the subject, and the comparativelj' short paragraph devoted to it
in the exhaustive work of the late Dr. MilUer, of Vienna," is indicative of the necessity for extending
our observations on the subject.
The recent outbreak of bubonic plague in Glasgow provided an opportunity of furnishing an addi-
tional contribution on the character and significance of the agglutinative phenomenon in this disease.
It has been my desire to gauge as accurately as possible the degree of completeness of the reaction at
several stages of the disease in the same individual, so that a basis for the estimation of its value at
any particular period may be established. The following record contains particulars of 24 cases
examined with this specially in view, and considerably over ."^OO agglutination tests have been per-
formed to furnish tlie strictly comparable data. The fact that the entire series of observations was
made by nij'self is mentioned only to indicate that the standard nf comparison by naked-eye examina-
tion of all the reactions has been practically uniform throughout.
Unfortunately, many of the earlier agglutinative experiments performed with plague serum m this
research were rendered of comparatively little value, owing to the fact that a mode of procedure was
adopted similar in all respects to that now in common use for obtaining the agglutinative reaction in
enteric fever. The method adopted for the latter purpose becomes inapplicable to plague because the
specific bacillus, unlike that of enteric fever, does not produce in peptone bouillon a homogeneous
turbidity during growth, but tends to cohere either in the form of strands of varying lengths (" stalac-
tites") or as minute floccules which are aggregated mainly on the sides and bottom of the tube, and
to a lesser extent occur throughout the fluid medium, It was found impossible by means of prolonged
agitation of such a culture to produce a homogeneous suspension of the bacilli. After such treatment
the micro-organisms were found to settle at the bottom of the tube in the form of a loose powdery
deposit, and on microscopical examination clumps of minute size were found throughout the super-
natant fluid. The most important condition for the performance of a trustworthy series of experiments
in agglutination or sedimentation — viz., an absolutely liojiiogeneous emulsion of the young organism —
is therefore, in the case of bacillus pestis, unobtainable with peptone bouillon. The cohesion of the
bacilli during growth in bouillon (possibly related to the development of an adhesive agent connected
with the capsules of the organisms by which zoogloea-like masses are formed) is also exhibited during
growth on the surface of agar-agar. If the surface of such a culture of 24 hours' incubator growth be
touched with a platinum loop its slimy consistence becomes at once apparent, and while the needle is
being removed a fine gelatinous thread is drawn out from the growth on the tip of the wire. This
becomes a more marked feature in slightly older cultures. The difficulty in obtaining such an enuil-
sion of plague bacilli was one which entailed a considerable amount of experimental work. It was
ultimately found that a homogeneous emulsion could be obtained in sterile 0'7o per cent, salt solution.
It is noteworthy that Dr. Klein, whose paper on the subject has recently appeared, has solved the
same difficulty after trial of various expedients in an almost precisely similar manner. This method
yields a perfectly homogeneous and workable emulsion which remains practically unchanged for 24
hours showing no signs of clarification in the upper portion of the fluid and no great tendency to the
deposition of micro-organisms at the foot of the tube. A drop of this fluid examined imder the micro-
scope shows the bacilli perfectly free and isolated from each other, and, if carefully prepared, ought to
be entirely free from any clump-formations.
The following was found the most suitable method of preparing the emulsion, which, in view of
the necessity of obtaining reliable comparative results in each case, was required in considerable
quantities. Several sloped agar tubes, which had been inoculated from a 24 hours' culture of bacillus
pestis, were incubated lor from 24 to 36 hours. Cultures which showed the presence of involution
forms in considerable numbers, or which had been incubated for longer periods than 48 hours, were
not (and should not be) used for this pui-pose. The tubes were then tilled with sufficient 0'75 per cent,
sterilised salt solution to cover the solid medium. The growth was then as far as possible transferred
to the salt solution. This was carried out most efficiently and without tearing the surface of the agar
in the process by rubbing the growth with the rounded extremity of a sterile Pasteur pipette, the end
of which had been previously curved in the form of a sliepherd's crook. The various eriuilsions so pre-
■ Recherches sur la Peste, Zabolotny, Archives des Sciences Biologiques, April, 1900, T. viii., No. 1.
2 The Lancet, fob. Ifitli, liJOl, p, 4;G. Hie Pest von Miiller und POch, 1001,
64
pared were then decanted into a large sterilised test tube, which was set aside for a short time to
allow any cohering masses which might be present to settle. If the growth had been very luxuriant
a more sensitive emulsion was usually obtained by diluting still further with salt solution. The exact
degree of dilution with salt solution is undoubtedly a matter of some importance and cau only be
determined after consideraV)le experience in agglutinative work. As a matter of frequent observation
it may be stated that too concentrated emulsions are agglutinated very slowly and often very imper-
fectly. In the following series of observations the emulsions were all prepared from the same stock
cultures, incubated for approximately the same length of time, and, as far as possible, grown under
exactly similar conditions. It need hardly be added that the cultures used responded to all the
recognised tests for the complete identification of the bacillus pestis. Inoculation of animals with
these cultures reproduced the disease with its characteristic lesions, and after death the specific
bacillus was recovered from the blood or organs.
In performing experiments on agglutination two chief methods are recognised: (1) the micro-
scopical and (2) the macroscopical or sedimentation method. The result of a considerable number of
C" mparative trials of both methods indicated that, on the whole, the latter yielded more reliable data.
By means o£ the microscopical method, however, pronounced aud in every way characteristic reactions
can be demonstrated in much higher dilutions than by the latter technique, but data so obtained are
frequently vitiated by the occurience at times of puzzling and apparently unaccountable pseudo-
reactions. Consequently, though tlie potency of a given serum was estimated in most instances by
both methods, only the sedimentation test was adopted throughout this series of observations as the
standard for performing comparative quantitative estimations, and no serum was regarded as yielding
a positive result which failed to give a satisfactory reaction by this method. The reactions were
carried out with serum separated directly from blood collected in sterilised Pasteur pipettes, care
being taken in every possible way to avoid its contamination. By so doing the possible introduction
of a fallacious factor in the means used for obtaining serum by a blister was avoided. The amount of
time absorbed in the careful separation of serum directly from blood necessarily limited the number
of observations made. It may be stated, however, that no visible difference either in the degree of
the reaction or in the time within which it made its appearance could be detected in several instances
where serum separated from blood aud that obtained from a blister were used from the same case and
at the same date for purposes of comparison.
Before undertaking a consecutive series of observations it is well to prepare beforehand all neces-
sary apparatus, so that no delay may take place at any stage which might interfere with or vitiate
the comparative value of individual reactions. Accordingly it was found advisable to have in readi-
ness a supply of ordinary Pasteur pipettes about 30 centimetres in length and an equal number of a
slightly modified pattern. The latter were provided with a capillary portion of a length equal to the
distance between the open extremity of the ordinary Pasteur pipette and the commencement of its
capillary portion ; in addition, a constriction or neck was fashioned on the upoer end of the tube about
three-quarters of an inch below the level of the cotton plug. Blood is most conveniently obtained
from puncture of a finger, the skin being first rendered sterile according to recognised methods. All
traces of antiseptics having been removed by a final washing with spirit, the finger is carefully dried
with aseptic gauze, and the pulp punctured with a sterilised bayonet-pointed needle. The drop of
blood which exudes is immediately aspirated into a sterilised Pasteur pipette, the sealed extremity
being first passed through a flame and then snapped across at a suitable level by means of sterilised
forceps. By "massaging" the finger from above downwards and aspirating each drop as soon as it
appears, a quantity, sufficient not only for the immediate performance of the reaction, but also for
purposes of comparison subsequently, can usually be obtained. In this way from half to one cubic
centimetre of blood may be furnished by a single successful puncture. During aspiration care should
be taken to avoid the introduction of any air-bubbles, as these interfere to some extent with the
formation of a firm coagulum and a resulting clear seriim. The fine extremity of the tube is then
sealed by drawing it out in a spirit flame, unnecessary heating of the contents being carefully avoided.
The pipette is kept in an upright position, and set aside in a cool place for several hours pending the
separation of the serum. If no air has been introduced a firm coagulum usually forms at once and
may be seen floating in the centre of the tube surrounded by a perfectly clear serum. If, however,
during the process of aspiration the blood has been more or less churned up with air, then it is better
to set the tube aside for from 12 to 18 hours. The resulting serum in this case is apt to contain a
considerable number of red corpuscles, and, though these in no way interfere with the satisfactory
performance of the reaction, a clearer serum is obtained if time be allowed for the sedimentation of the
red corpuscles. The separation of the serum from the coagulum is effected by means of the modified
pipettes. The cotton-wool plug being removed from the tube containing the blood, the sealed ex-
tremity of a modified pipette is first snapped across with sterilised forceps, the capillary portion
introduced into the former and carried down to the conical narrowing of the tube. The clear serum
is then aspirated into the second tube, and the capillary portion sealed at a suitable level bv drawing
out in a flame. Before doing so, however, the precaution should be observed of aspirating all the
fluid into the body of the tube so as to avoid any undue heating of the serum. If the preservation of
the serum for any length of time is desired the pipette may easily be converted into a hermetically-
sealed capsule by drawing out the constricted portion in a Bunsen flame. On accoimt of the difficulty
of preparing two emulsions of exactly the same density it is always better to subject at one time as
large a number of sera as possible to the influence of a single emulsion. For the same reason when
performing quantitative estimations it is absolutely necessary to compare the agglutinating power of
the serum under observation with that obtained at a previous date, the potency of which has already
been ascertained by repeated experiment. Only by so doing is it possible to establish an arbitrary
65
standard and so gain an accurate conception as to the quantitative value- of individual reactions..
When results materially disagreed with previous observations the data so obtained were disregarded,
and the series of reactions again observed with a fresh emulsion.
The reaction is conveniently performed in test tubes about 9 centimetres in length, prepared from
ordinary soft-glass tubing of about 07 centimetre internal diameter. These are thoroughly cleansed
and dried, the open extremity being closed with a plug of cotton-wool. After sterilisation at a tem-
perature of 160° C. for an hour they are ready for use. In all cases the reaction was carried out in at
least three dilutions, and in many instances with sera possessing a high degree of potency in five dilu-
tions. The proportions adopted throughout have been 1 in 10, 1 in 25, 1 in 50, 1 in 75, and 1 in 100.
In no case has an undoubted reaction been obtained in a dilution higher than 1 in 75, and reactions
lower than 1 in 10 have not been recorded, as the necessarily large relative dilution of serum with the
emulsion in such preparations j'ields a practically clear fluid in which the determination by the naked
eye of any agglutination becomes a matter of extreme difficulty.
The reaction is conveniently performed as follows. A long Pasteur pipette is taken and its capil-
lary portion snapped across at a level corresponding in diameter with that of the capillary portion of
the pipette containing the serum under examination. It is thus ensured that drops issuing from the
orifices of these two pipettes will have as nearly as possible the same volume, and in this way any
required dilution of serum with emulsion can be readily performed. The Pasteur pipette, the wider
portion of which is guarded by two cotton-wool stoppers to prevent possible accidents during inspira-
tion, is filled with the bacillary emulsion. A drop of serum having been introduced into each of a
series of sedimentation tubes the emulsion of bacilli is added to each, drop by drop, to produce the
requisite degree of dilution. The serum and emulsion are thoroughly mixed, and the cotton-wool
stopper is replaced in the sedimentation tube. It is convenient to place vertically in a small deep
box the requisite number (from three to five) of sedimentation tubes for each serum under investiga-
tion. This obviates the necessity of labellins each tube, and at the same time prevents confusion.
The degree of dilution can then be readily inferred from the volume of fluid in each tube. When com-
pleted the whole series is set aside in a cool chamber for from IS to 2i hours. As control experiments
in each series two or more tubes containing (1) a quantity of the bacillary emulsion, and (2) emulsion
-f normal serum in corresponding dilutions were employed. If at the end of 24 hours any degree of
sedimentation had taken place in these latter the data obtained from this series were not recorded.
Under ordinary circumstances, however, no changes were observed in the control tubes, whilst in the
case of those containing serum from a convalescent plague patient a remarkable alteration became
apparent after a variable interval of time and according to the potency of the serum. The emulsion
was seen to clarify from above downwards till practically the entire column of fluid became absolutely
clear. This change was due to the precipitation of bacilli to the lower part of the tube, where they
form a loose flocculent deposit. On examining this bacillary deposit under the microscope it was
observed that the capsules of the organisms had become indistinct. In the case of powerfully agglu-
tinative sera the process m.-iy be observed to commence after one or two hours, but as a rule the
reaction is rarely completed till 24 hours have elapsed. Consequently the latter has been adopted as
the uniform time limit throughout this series of investigations. In high dilutions or when dealing
with sera of feeble agglutinative power the reaction, as might be expected, is less complete. Com-
parison with the control tubes, however, show that, while a certain degree of clarification and precipi-
tation has occurred at the end of 24 hours, the process has stopped short of completion, leaving a
slightly opalescent appearance in the tube. In the following tables such reactions are indicated by
the sign -t-f (feeble), as the precipitated microbes showed the same microscopical changes as incomplete
reactions. A complete reaction is indicated by the positive sign + whilst the negative sign — indicates
that no reaction has taken place. In the case of powerfully agglutinative sera, when clarification of
the emulsion occurs soon after performing the dilution (from one to two hours), the double sign-f +
has been used.
The following tables represent in a condensed form the result of over 300 separate agglutination
tests of the serum taken at different stages of the illness from 27 plague patients. Detailed clinical
histories have been purposely omitted in this paper, but it has been deemed advisable to add short
clinical r4su7n4s of those mild cases in which bacteriological confirmation of the diagnosis was not
available. The cases examined, with one exception, which will be referred to later, were all of the
bubonic type, and, of these, nine received at one time or other varying doses, either subcutaneously
or intravenously, of Yersin's anti-plague serum. The agglutinative reactions in these cases, however,
were probably not modified to any considerable extent by the previous administration of the serum
for curative purposes. In support of this it may be here remarked that the blood serum of individuals
who had received one or more prophylactic doses of this serum showed no evidence whatever of
agglutinating power. It is, therefore, highly improbable that the data so obtained have been vitiated
in the slightest degree, as even the remedy itself when mixed with a highly sensitive emulsion fails
to produce any visible change after the lapse of 24 hours. With the view of ascertaining the possible
effect of a mixed infection on the agglutinative reaction 1 undertook a complete bacteriological
examination of most of the organs in fatal cases of plague. These results are appended in Table I.
Reference to the cases in Table II. shows that the presence of micro-organisms other than the
bacillus pestis in the blood or organs of a patient dead from bubonic plague does not prevent the
development of the specific reaction.
For purposes of classification the cases have been arranged in the following groups.
Table II. shows the results obtained from six fatal cases, in all of which the presence of the bacillus
pestis was verified by reproducing the disease with its characteristic lesions in animals. Cultures of
the specific bacillus were obtained during life, either from the bubo or blood of the patient, or post
66
mortem from the various organs. These were either injected subcutaneously or a small quantity of an
agar growth placed in the nasal cavity of an animal and the bacillus again recovered from the tissues
after its death. In this group of cases the reaction was also demonstrated with other body fluids —
viz., pleural effusion, pericardial effusion, peritoneal fluid, and bile. With respect to the first three
of these it will be observed that, in comparison with blood serum, a relatively high degree of aggluti-
nation has been noted in the only three cases in which it was possible to perform the test with these
morbid exudations.
Table III. comprises those severe cases terminating in recovery, from all of which, with one ex-
ception (Mrs. M.), the bacillus pestis was obtained by puncturing the bubo. A sterilized hypcdermio
syringe was inserted into the glandular swelling, and from the serous fluid withdrawn the specific
organism was demonstrated on direct microscopical examination of smear preparations. Culturally
the organism isolated from each case responded to all the recognised tests for the identification of
Yersin's bacillus, and, as in the first group of cases, was further verified by the biological test. In the
case of Mrs M. it was thought unnecessary to perform a bacteriological examination of the bubo, as
the patient's daughter (Mrs. M.), granddaughter (baby M. ), and son (Robert M., see Table II.), all
died from bubonic plague. A special report regarding the last case in this table is given on
page 55.
Table IV. comprises those comparatively mild cases of plague with characteristic bubo. From
the first three of these the specific organism was isolated and identified as above, but only in the case
of Mrs. G-. was the proof completed by animal inoculation. In the last three cases (James C, Rosina
M., and Dennis T. ) it was found impossible to cultivate the organism either from the juice obtained
by puncture of the glands, or at a later stage when the bubo had broken down from the sero-purulent
discharges. The failure to obtain the bacillus in these cases was no doubt due to the comparatively
late stage of the illness at which the patients first came under observation. As the disease ran an
exactly similar course, however, to those from which the specific organism had been recovered, and as
in each instance the serum possessed marked agglutinative power, there appears to be every possible
reason to regard them as undoubted though mild cases of plague. The following synopsis of the
clinical features of these cases reveals their character sufiiciently : —
Dennis T. (Case 6), aged 5 years. This patient was admitted on the eighth day of illness
with a glandular swelling in the right inguinal region which presented the characteristic appearance
of a plague bubo in the stage of resolution. The enlargement was limited to the vertical set of
glands, the skjn over and around it being inflamed and exceedingly tender. The patient, though
not acutely ill, was drowsy and showed a lack of interest in his surroundings. Examination of the
heart and lungs revealed nothing noteworthy. The admission temperature of 100 '4° F. was never
exceeded, and a few days later the patient seemed quite well, though the bubo, while less tender,
showed no signs of resolution. On the sixteenth day of illness spontaneous rupture of the bubo took
place, convalescence thereafter being rapid and complete. Cultures from the bubo, made as above
described, proved sterile, though smear preparations showed the presence of numerous degenerated
bacilli. No doubt, however, can be entertained as to the nature of this patient's illness both on
account of the association and the clinical appearances. The patient's grandfather (James B.,
Table II.) died from plague, and his mother (Mrs. T., Table III.) passed through a very severe attack
of this disease. The identity of the isolated organisms in both these latter cases was verified by
animal experimentation.
James C. (Case 4), aged 24 years. This patient was admitted to hospital on August 30th, 1900.
On August IGtli he was seized with an illness, evidently of considerable severity, associated with
headache, sickness, and vomiting, and pain in the left inguinal region. The report received from the
medical attendant, Dr. G., is as follows : — On August 17th the temperature was 103° F., and the pulse
102. There was severe headache with vomiting. The patient complained of pain in the left inguinal
region, where there were some redness and swelling. On tlie 21st the temperature was 102'6°, the
pulse 98, while the swelling had increased in size and was still painful. On the 24th the temperature
was 100, and the pulse 90. The swelling was sausage-shaped and lay along the upper border of
Poupart's ligament ; it was fairly hard and pitted on pressure. On admission the patient was
evidently convalescent, no sign of illness being present. The temperature was normal. On examina-
tion of the left groin, however, a swelling rather larger than a pigeon's egg was discovered
immediately above Poupart's ligament, and evidently involving the horizontal set of glands. The
overlying skin was inflamed and slightly cedematous, and fluctuation could be easily obtained. A
hypodermic needle inserted into the glandular swelling withdrew a quantity of dark grumous fluid,
"which, on microscopical examination, showed the presence of numerous degenerated bacilli ; and
though a considerable number of agar tubes were inoculated on two separate occasions, no growth
whatever could be obtained. Convalescence was uninterrupted, the bubo disappearing by absorption.
Rosina M. (Case 10) was admitted from the plague -infected area in her third week of illness. At
this date all clamant symptoms had subsided, but examination of the inguinal region on each side
showed the presence of a bilateral bubonic condition involving the group of glands situated imme-
diately above Poupart's ligament. Each bubo was about the size of a large walnut, that on the left
side being comparatively firm and painless, whilst in the other fluctuation could be easily detected.
On both sides the overlying skin was inflamed and adherent to the glands beneath. The history of
the illness obtained from various sources showed that the onset was sudden and acute, and was
characterised by high fever (temperature 104"^ F. ), accompanied by rigors and delirium; headache,
sickness, and vomiting were also present, and continued for some time after the appearance of the
buboes, which were discovered by the patient herself on the third day of illness. These were
apparently exceedingly painful at this stage. They rapidly increased in size during the succeeding
67
two or three days, after which the tenderness slowly subsided. The bubqj.in right groin ruptured
spontoneously in the fourth week of illness, discharging a sero-purulent fluid for about 10 days,
whilst that ou the left side underwent resolution without rupture. Both buboes were explored with
a hypodermic needle as in previous cases, and culture tubes inoculated with the aspirated fluid
remained sterile. At a later date the subcutaneous injection of a mouse with the discharges from the
right bubo was unattended by any serious disturbance in the animal's health.
The remaining cases grouped in Table V. may be regarded, both from the etiological and clinical
standpoint, as fairly typical examples of pe.ttis anibvhiiis. In all the illness was apparently so slight
that, apart from a definite history of contact with infected persons, and in the absence of a bacterio-
logical examination, it would have been quite impossible to pronounce upon the exact nature of the
glandular affection. The general course and s3'mptomatologj' of such cases has already been described
in a previous article, and it will therefore be sufficient here to indicate briefly the salient points of
each case.
Of these the most interesting is the case of a ward-maid in one of the pavilions set apart for the
isolation and treatment of plague patients. Ten days prior to the commencement of her illness she
had received a prophylactic injection of 10 cubic centimetres of Yersin's serum. The illness, however,
was of a comparatively trifling nature, the patient only complaining of a moderate degree of indisposi-
tion for about three days. Bacteriological examination, however, demonstrated the presence of the
plague bacillus in an exceedingly small cervical bubo. The serum taken during the third week of
illness agglutinated an emulsion of plague bacilli in a dilution of 1 in 25, though the constitutional
disturbance was so slight that the temperature and pulse throughout the illness never rose above
normal.
-Agnes R. (Case 17), aged three and a half years. This patient was a "contact" from the Molloy
wake — one of the first discovered foci of infection. The illness, of sudden onset, was accompanied by
headache, sickness, and vomiting, and pain in the left axilla. Examination of this region showed the
presence of a small bubo, but an exploratory puncture failed to withdraw any lymphatic gland fluid.
The temperature rose to 101° F. on the first day of illness, and subsided to normal two days later.
Convalescence was rapid and complete.
In the remaining three cases the sudden appearance of bubo (axillary in one case, cervical in the
others) was associated with symptoms of fairly acute onset, similar in all respects to those already
described. In these, however, a bacteriological examination was not undertaken, but the peculiar
nature of the illness, taken in conjunction with a very definite history of exposure to infection, seems
sufficient to warrant these cases also being regarded as examples of the mildest variety of this disease.
It may here be added that the serum of patients suffering from various forms of specific infectious
disease, and taken at various stages of their illness was examined in different degrees of dilution with
an emulsion of bacillus pestis. In no case was any reaction observed. The diagnostic value of its
appearance, therefore, in oases associated with slight glandular enlargement is to this extent
enhanced.
The following deductions appear fully warranted from an examination of the accompanying
tables : — 1. During the earlier days of the disease the reaction is not manifested, and consequently in
rapidly fatal cases is probably never obtained. 2. Agglutinating properties first appear in the blood
towards the close of the first week of illness (dilution 1 in 10). These gradually increase in intensity
up to the sixth week of illness, and are sometimes maintained at a high level as late as the eightli
week. After this date, however, in the majority of cases a gradual decline in the agglutinative power
of the serum becomes apparent. The rates of increase and decrease of the reaction, generally speak-
ing, are approximately equal ; occasionally, however, the reaction wanes and disappears in a shorter
period than that occupied between its appearance and point of maximum intensity. 3. In very
severe cases ultimately proving fatal, the reaction, though present, never reaches a high degree of
intensity. In cases of almost equal severitj^, however, in which an early and rapid convalescence
followed, the reaction was of a more marked character. 4. In the mildest forms of plague a high degree
of agglutinating power is probably never attained, and in some it appears to be absent. Strieker, in
fact, states that tlie reaction never appears in this class of case ; but this is undoubtedly too sweeping
an assertion, as an undoubted and characteristic reaction in a dilution of 1 to 25 was obtained in
two such cases. 5. The reaction, as a rule, is most marked in those severe cases cliaracterised
by an early and favourable crisis, and in such cases it disappears very slowly, having been shown
to be present as late as the fifth month after the primary illness.
Other methods. — The technique just described is, however, perhaps unnecessarily complicated, as
in order to avoid any possible source of fallacy a number of precautions were adopted which later
experience showed to be superfluous. The initial difficulty — the preparation of a perfectly homo-
geneous bacillary emulsion — having been overcome, an almost precisely similar technique to tliat
employed in the ordinary Widal reaction may be adopted. As already stated, the dilution of serum
with emulsion can be carried to a much higher degree, and the time-limit considerably shortened
when the microscopical method is employed. By this means reactions in which the bacilli are
completely agglutinated in from 5 to 10 minutes are fairly common with potent sera in dilutions of
1 in 10 and 1 in 25. If, however, the dilution be carried further, it is absolutely necessary for
trustworthy results to observe the reaction in hanging-drop preparations. In this way well-marked
reactions have been obtained in dilutions of 1 in 200 with a time-limit of two hours, though prepara-
tions made between an ordinary slide and cover-glass showed no evidence whatever of any
agglutinative process. The time-limit may be safely extended to 24 hours if the edge of the cover-
glass be sealed with vaseline. By this method a reaction can often be demonstrated with sera of
feeble agglutinative power, or with potent sera which have been highly diluted. As a control
68
experiment, preparations of (1) emulsion and (2) emiilsion plus normal serum have been kept for over
a week without any signs of undoubted agglutination supervening. Numerous observations of plague
sera in progressively increasing dilutions have been made, and the time-limit in each case has been
carefully noted. The data so obtained may be compared with those got by the sedimentation test at
corresponding periods. To illustrate this, the results obtained by this method from two severe cases
of plague terminating in recovery (Table III.) are exhibited in the accompanying table (Table VI.).
Like results may be obtained with similarly prepared emulsions of dead plague bacilli, but in
this case the reaction is not so reliable, as the dead organisms are not agglutinated so readily. When
working with dead cultures, however, the microscopical is to be preferred to the sedimentation
method, since it yields more trustworthy results even in higher degrees of dilution. In the absence
of facilities for obtaining a homogeneous emulsion of living or dead bacilli, Haifkine's prophylactic
(which contains the latter) may be used to dilute a suspected plague serum. No satisfactory reaction,
however, has been got by this means in a higher dilution than 1 in 25, and the sedimentation method
is alone applicable owing to HafFkine's prophylactic being a bouillon culture. This last method can
only be regarded as a makeshift.
Gondudivq remarks. — From the point of view of hygienic administration, the very mild cases of
plague are of the utmost importance. The analogy presented by all other infectious diseases
indicates that such cases must be regarded as of equal importance with the more severe forms in the
possible dissemination of the disease, and constitute, therefore, a grave source of danger to the
community. It is well known that epidemics of measles, scarlet fever, and diphtheria are frequently
preceded by a type of the disease so mild that many cases are allowed to remain untreated, and it is
interesting to note that several of the outbreaks of plague in the East have been heralded by the
mildest possible form of the disease. Moreover, the difficulties attendant on a successful exploratory
puncture of a small deep-set gland are sufficiently obvious, and any other means of arriving at a
definite conclusion as to the nature of an obscure glandular swelling is certainly entitled to the most
careful consideration.
In the severer forms of the disease the possibilities of a serum diagnosis are much greater. It
has already been shown that during the early stages of the illness the agglutinative properties of the
blood are but feebly developed, and that unless a careful technique be adopted for its demonstration
the reaction is liable to be missed altogether. After the second week of illness, however, and
particularly in those cases where the bubo undergoes resolution, the chances of obtaining the bacillus
by puncture of the gland diminish rapidly during convalescence. This fact is well illustrated by the
last three cases in Table IV. , in which attempts to cultivate the organism by this method at the end
of the first, second, and third weeks of illness respectively completely failed, though numerous
degenerated bacillary forms were seen in smear preparations. Indeed, in the case of Mrs. M.
(Table III.) culture tubes inoculated on the 8th day of illness with fluid obtained from puncttire of
the bubo proved sterile, though two days previously an actively growing pure culture had been
obtained. On the other hand, the agglutinative power of the serum, insignificant at the commence-
ment of the illness, progressively increases up to the sixth or seventh week of the disease, by which
time a comparatively high degree of potency has been attained, especially in the severer forms of the
disease which recover. Thereafter it begins to decline, but, as already shown, may be present in
well-marked cases four or five months after the primary illness. It is, therefore, during and
subsequently to the stage of convalescence, when the possibility of a bacteriological diagnosis is more
or less remote, that the diagnostic value of the reaction becomes most apparent. In all cases,
moreover^ associated with the presence of glandular enlargements of dubious nature, the occurrence
of which from time to time during the progress of an epidemic of plague may present a diagnostic
problem of perplexing character, the application of this reaction cannot fail to prove of signal
service.
69
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70
Table II. — Fatal Cases.
Case
No.
Name.
Age.
Day of illness
on admission.
Date of
examination of
serum, &c.
Nature of fluid
examination.
Amount of
serum
fYersin)
injected.
Result of
bacterio-
logical
examina-
tion.
Result of
animal
inocula-
tion.
Dilution of serum with
emulsion of bacillus
pestis in proportions of —
1 in 10
1 in 25
1 in 50
22.
Mrs. M.,
20
Third day.
Third day.
Blood, post mortem.
60 CO.
+
+
—
-
-
28.
BabyM.,
7 days
Seventh day.
Blood, post mortem.
Pleural effusion.
+
+
+
-1-
+
-
27.
Mary G. ,
6
Second day.
Fourth day.
Seventh day.
Blood serum.
Blood, post mortem.
Pleural effusion.
100 CO.
+
+
+
+ f
+
+
+ f
25.
Robert M., -
12
Third day.
Twelfth day.
Blood, post mortem.
Pericardial effusion.
Peritoneal effusion.
80 CO.
+
+
+
+
+
+
1.
James B.,
GO
Fourteenth day
Sixth week.
Blood, poat mortem.
+
+
+ -1-
+
11.
William W.,
48
Fourth week.
Sixth week.
Blood, post mortem.
Bile, post mortem.
+
+
-1-
4-
+ f
+ f
Table III. — Several Cases ending in Recovery.
Case
N
Name.
Age.
Date of illness on
admission.
Date of serum
examination.
Amount
of serum
(Yersin)
injected.
Result of
bacterio-
logical
examination.
Result of
animal
inoculation.
Dilution of serum with emulsion of bacillus
pestis in proportions of —
I in 10
1 in 25
1 in 50
lin 75 [linlOO
3.
Pat. F.,
56
Second week.
Seventh week.
Twelfth week.
+
+
+ +
+ +
+
+
+
5.
Mrs. M., -
40
Sixth day.
Third week.
Sixth week.
Ninth week.
Twelfth week.
+
+
+
+ +
+
+
+ -1-
+
+ f
+ +
+
+ f
o
Mrs. T., -
40
Thirteenth
day.
Third week.
Eighth week.
Tenth week.
Twelfth week.
+
+
+ +
+ +
-t-
-1-
+
+
+
+
+ f
9.
Thomas H. ,
15
Seventh day.
Fourth week.
Fifth week.
Sixth week.
Eighth week.
Eleventh week.
Fifth month.
40 c. c.
+
4-
+ +
+
+ +
+ +
+ +
+
-1- +
-t-
+
+ +
+ +
-t-
+
+
-1-
+
+ f
+ f
19.
Charles M.,
27
Second day.
Sixteenth day.
Fourth week.
Sixth week.
Eighth week.
Four and a half
months.
40 c. c
+
+
-1-
+
+ +
+ +
+
+
+
+
+
+
+
-t-
+ f
23.
Mrs. M., -
41
Second day.
Seventh day.
Eighteenth day.
Fifth week.
40 c.c
-1-
+
+
-f-f
+
+
-1-
+ f
X
Adam A., -
18
Second day.
Sixtii day.
Second week.
Sixth week.
Ninth week.
+ 1
+
+
+
+
+
+ ?
1
71
Table IV.— Mild Cases.
Case
No.
Name.
Age.
Day of illness on
admission.
Date of serum
examination.
Amount
of seram
(Yeisin)
injected.
Result of
bacterio-
logical
c X tiiTi 1 n ut'l oti .
Result of
animal
inoculation.
Dilution of serum with emulsion of bacillus
pestis in proportions of-
1 in 10
1 in 25 j 1 in 50
1 in 75
1 in 10(
24.
Mary M., -
14
Second day.
Sixth day.
Sixteenth day.
Third week.
Fifth week.
40 c.c.
+
+
+
+ +
+
+
+ f
20.
Mrs. B., -
29
Second day.
Ninth day.
Eighteenth day.
Sixth week.
40 c.c.
+
+
+ +
+ f
+ f
-
26.
Mrs. (jr.,
28
Second day.
Third week.
Fourtli week.
Sixtli week.
Eii^''hth week.
Four and a half
months.
+
+ +
+
+
+
+ +
-J- +
+
+
H — h
+
+
-
4.
James C, -
24
Third week.
Tliird week.
Fifth week.
Seventh week.
Ninth week.
+
+
+
+
+ ?
+
+
+
+ ?
6.
Dennis T., -
6
Ninth day.
Fifth week.
+ +
+ +
+
10.
RosaM.,
28
Third week.
Fifth week.
+
+
Table V.— Cases of Pestis Ambulans.
Case
No.
Name.
Age.
Day of illness on
admission.
Date of serum examina-
tion.
Result of
tacterio-
logical
examination.
Amount
of serum
(Yersin)
injected.
Dilution of serum with emulsion of
bacillus pestis in proportions of —
1 in 10
21.
Nellie E.,
17.
Agnes R. ,
14.
Arch. D.,
8.
William M.,
15.
Jeanie M.,
13.
Annie M'K.,
16.
Pat. M'G.,
21
3i
18"
3
14
12
18
Second day.
First day.
Seventh day.
Fifth day.
Second day.
Second day.
Second day,
Third week.
Second week.
Fourth week.
Twentieth day.
Second week.
Second week.
Fovirth week.
10 c.c.
+ f
H-
+
Table VI. — Microscopical Serum Acglutinations.
Thomas H. (Case No. 9).
Date of serum
tion
10.
c
o
c o
3 '■'2
tion
75.
0)
tion
100.
3 ^
Il
tion
300.
examination.
C
- .3
a
3 g
£
B c
s
= e
a
3 '1
= c
a
s
H
5
W
H
H
H
H
H
a'Z
Fifth week,
+
+
5 mins.
+
+
ilO mins.
+ +
15 mins.
+ +
30 mins.
+ +
1 hour.
+
45 mins.
Eighth week.
+
+
5 mins.
+
+
10 mins.
+ +
15 mins.
+ +
20 mins.
+ +
1 hour.
+
1 hour.
+
2 hours.
Eleventh week, -
+
+
5 mins.
+
+
20 mins.
+ +
30 mins.
45 mins.
+ f
1 hour.
+
1 hour.
+
1 hour.
+ f
2 hours.
Four and a half
months, -
+
+
10 mins.
+
+
'30 mins.
+
1 hour.
+ +
+ f
2 hours.
18 hours.
Cliarle
s iV. (Case No. 19 J.
Fourth week.
+
+
5 mins.
+
+
10 mins.
+
1 hour.
+
2 hours.
+ f
12 hours.
18 hours.
Sixth week,
+
+
5 mins.
+
+
10 mins.
+ +
45 mins.
+
2 hours.
+ f
2 hours.
+ f
4 hours.
Eighth week.
+
+
5 mins.
+
+
15 mins.
+ f
2 hours.
Four and a half
months, -
+
+
20 mins.
+
+
30 mins.
+ f
2 hours.
J
73
MORBID ANATOMY AND BACTERIOLOGY.
By R. M. Buchanan, M.B. (Glas.), F.F.P.S.G., Bacteriologist to the Corporation.
The morbid anatomy and bacteriology of plague as observed in the outbreak
in Glasgow during the autumn of 1900 are considered in this Report under the
following divisions : — -
Introductory.
Details of Morbid Anatomy as Recorded in Post - Mortem
Reports, and Notes thereanent.
Microscopical Examination of the Fresh Tissues.
Microscopical Examination of the Tissues in Section.
Culture Experiments.
Inoculation Experiments.
Mode of Infection.
Bacteriological Diagnosis.
Precautions Observed in Connection with Post - Mortem
Examinations and Inoculation Experiments.
Examination of Rats in Relation to the Outbreak of Plague
in Glasgow.
INTRODUCTORY.
It has been reckoned that at least 36 persons were attacked during the out-
break, and that 16 succumbed to the disease. Of the fatal cases, 7 died in their
own homes before the disease declared itself, and were inferentially regarded as
Plague from their definite association with authentic cases, and 9 died in Belvidere
Hospital. One of the latter appeared in the Hospital Returns as " Typhus," and
the true nature of the case was only revealed on post-mortem examination. The
post-mortem records deal with seven cases.
The post-mortem examinations were conducted at Belvidere Hospital, and
followed up by bacterioscopic investigation at the Hospital, and at the Public
Health Laboratory. The first examination was conducted by Professor Muir, of
Glasgow University, in my absence, and the last by Professor Pertik, of Buda-Pesth.
The condition of the bodies as regards nutrition was notably good where death
had occurred early in the course of the illness, while emaciation was more or less
evident in the cases of longer duration.
The presence of petechise in the skin was noted in two cases only. In one of
these there was also a faint macular staining over the abdomen (a condition which
clinically had contributed to a provisional diagnosis of typhus). There were no
gross hemorrhagic lesions visible in the skin, but in about one-half of the cases
extravasations of blood were discovered in various tissues and organs.
In all the bodies some swelling was evident either in the groin, the arm-pit,
or the neck, constituting the characteristic bubo.
The tendency of this characteristic lesion to occur with much greater frequency
in the groin than in other parts was shown by its presence in this region in four of
the seven cases. In other two cases the primary bubo was situated in the axilla
with a secondary bubo in the neck in the one and in the mediastinum in the other,
while in the remaining case multiple buboes appeared in both sides of the neck.
The bubo in each instance was formed of a group of lymphatic glands in a
setting of oedematous, haemorrhagic, or indurated connective tissue. In four of the
seven cases the bubo was in a more or less acute stage, unaccompanied by any very
manifest lesion in the internal organs ; in two it was complicated with pneumonia ;
and in the remaining one it had reached a stage of complete necrosis and
sloughing.
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It will thus be seen that the cases naturally grouped themselves into three
classes according to the lesions presented, namely —
1. Acute bubonic cases, without complication.
2. Acute bubonic cases, complicated with pneumonia.
3. Chronic bubonic case, with necrosis and sloughing.
DETAILS OF MORBID ANATOMY.
The details of the morbid anatomy are fully recorded in the post-mortem
reports appended to the clinical histories of the fatal cases, and it is, therefore,
unnecessary to present these reports again in full. But, in order to permit of a
collective view of the cases from a pathological standpoint, and to facilitate
reference to outstanding features in their morbid anatomy, the post-mortem reports
are epitomised and grouped together here in the three classes just mentioned.
Above each epitome will be found the case number, the initials and age of the
patient, the approximate period of incubation, the duration of illness, and the date
of examination.
I. — Acute Bubonic Cases without Complication.
Case 7.— P.M., aged 20 Years.
Approximate Period of Incubation, 3 Days. Duration oj Illness, 5 Days.
Post-mortem Examination, SSth August, 1900.
Bubonic enlargement of axillary and cervical glands, with periglandular oedema and hsemorrhage.
Hsemorrhagic adenitis with marked swelling of mediastinal, prevertebral, and inguinal glands.
Heart muscle paler than normal, but not specially soft. Hypostatic congestion and some collapse
of the lungs, but no pneumonia ; the glands at the root not visibly affected. No fluid in the pleural
cavities. Spleen enlarged, weighing 12-^ ounces, and softer than normal; splenic pulp pale and
mottled, and nialpighian bodies small but distinct. Liver swollen, pale, and soft, with parenchyma-
tous degeneration in a marked degree. Kidneys swollen and soft, owing to cloudy swelling of cortex.
Pancreas and supra-renals also swollen and soft.
Bacterioscopic Examination. — Bacillus pestis in buboes in enormous numbers.
Case D. — Mks. G., aged 65 Years.
Approximate Period of Incubation, 10 Dayn. Duration of Illness, I4 Daya.
Post-mortem Examination, 4th September, 1900.
Left inguinal bubo involving the transverse set of glands and forming a sausage-like swelling
along the line of Poupart's ligament. The individual glands of the bubo are about f of an inch in
diameter, and appear as well-defined abscesses, walled by a thin rind of hssmorrhagic gland tissue,
containing shreds of necrosed tissue and brownish viscid pus. Periglandular tissues cedematous
and densely matted together. Pvight inguinal glands (transverse set) hyperffimic and enlarged, one
being the size of a marble, hssmorrhagic and purulent. Iliac and prevertebral glands of left side
hypersemic and enlarged. Glands in other parts appear normal. Faint typhus-like macular staining
of abdomen. Petechia on abdomen and thighs. Heart muscle pale brown, soft and flabby. Lungs
hyperasmic and cedematous, the right lower lobe showing some areas of consolidation. Spleen soft
and dilBuent. Liver and kidneys manifest parenchymatous degeneration.
Bacterioscopic Examination. — Bacillus pestis not recovered from bubo.
Case 18. — G.H., aged 46 Years.
Approximate Period of Incubation, 7 Days. Duration of Illness, 10 Days.
Post-mortem Examination, 13th September, 1900.
Right inguinal bubo, with periglandular oedema and hoemorrhage. The bubo comprises the
vertical set of glands which vary in size from that of a pea to a walnut, the distal gland being the
largest, and presenting a granular l)rownish-red marbled appearance, somewliat resembling a mixed
thrombus in transverse section. The retroperitoneal gland just above Poupart's ligament shows the
same hsemorrhagic enlargement. The prevertebral glands on the right side and the inguinal glands
on the left side are slightly enlarged and intensely hj'perasmic. Bronchial glands enlarged and
infiltrated with blood. The lymphatic glands of the neck and axillae are conspicuous by their
red colour. The loose connective tissues in the neck and in the posterior mediastinum are infiltrated
with blood. Subpericardial ecchymoses and some parenchymatous degeneration of heart muscle.
Large exudation of fluid in both pleural cavities. Lungs hyperaBmic and cedematous. Spleen somewhat
soft and hyperaemic. Liver normal in size, but presenting cloudy swelling in a marked degree.
Kidneys large and hyperaemic, and the loose tissues in the hilus of each extensively infiltrated with
blood. In the mucous membrane of the stomach and intestines numerous small punctiform
haemorrhages are found.
Bacterioscopic Examination. — Bacillus pestis in bubo ; in prevertebral, bronchial, and left inguinal
glands ; and in blood, lungs, spleen, liver, and kidneys. Pneumococcus in bubo, left inguinal gland,
lungs, and kidneys.
(Figs. 1, 8, 24, 25, and 26.)
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Case 22. — Mrs. M,, aged 20 Yeaes. ^
Approximate Period of Incubation U7icertain ; Gasf in household IG Days previously.
Duration of Illness, 3 Days.
Gave birth to Child in Hospital (Baby M., Case Ho. 28).
Post-mortem Examination, 18th September, 1900.
Right inguinal bubo, comprising vertical set of glands and retroperitoneal gland just above
Poupart's ligament, with periglandular cedema. The various glands of the bubo are fully half an-inch
in diameter, of firm consistence, intensely hypersemic and finely mottled. Prevertebral glands on same
side also notably affected. The lymphatic glands generally, including those of the mesentery, are
slightly enlarged and hyperaemic. Skin pale, and no cutaneous hosmorrhage evident ; some putrefac-
tive discolouration of abdomen. Heart firm in consistence, with subpericardial ecchymoses at apex of
left ventricle, and some cloudy swelling of myocardium. Hypostatic congestion of the lungs. Liver,
spleen, and kidneys somewhat hyperjemic. Uterus characteristic of recent delivery.
Bacterioscouic Examination. — Bacillus pestis in bubo, blood, lungs, liver, and spleen. Pneumo-
coccus in bubo and lungs. Streptococcus in lungs.
(Figs. 9, 10, 11, and 27.)
These cases formed a series in which the buboes were exhibited in various
stages, from the earUer stage of congestion and hajmorrhage to the later one of
softening or suppuration. These stages corresponded with periods of illness, ranging
from three to fourteen days. Periglandular oedema, alone or with hsemorrhage, was
a marked feature of the swelling. The appearance of the glands was very remark-
able. The somewhat dry, granular, brownish red, finely marbled or mottled cut
surface, betokening congestion, haemorrhage, and necrosis, was characteristic, and
quite distinct from other glandular affections.
In each case, also, there was considerable involvement of the neighbouring
group of glands, and more or less ]:)olyadenitis, as evidenced by some hyperemia
and enlargement of the lymphatic glands generally.
The larger viscera presented no marked departure from the normal. In the
heart, liver, and kidneys there was some cloudy swelling, and the spleen was more
or less soft and hypersemic. Extravasations of blood, apart from the buboes, were
found in two of these cases (G. H. and Mrs. M.). In both there were subpericardial
ecchymoses, while in the former there was also extensive hsemorrhage in the loose
cervical, mediastinal, and retro-peritoneal tissues.
II. — Acute Bubonic Cases complicated with Pneumonia.
Case 28. — Baby M., aged 10 Days.
Approximate Period of Incubation, 8 Days. Duration of Ilines<, 3 Days.
Child of Mrs. M. (Case No. 22); born in Hospital.
Post-mortem Examination, 27th September, 1900.
Buboes on both sides of neck. General enlargement and hyperemia of axillary, bronchial,
mesenteric, inguinal, and prevertebral lymphatic glands. Hemorrhage and cedema of subcutaneous
tissue of neck. Marked parenchymatous degeneration of heart, liver, and kidneys, and coagulation
necrosis of right supra-renal capsule Numerous small hseniorrhagic condensations in lungs, many of
which show a yellowish necrotic centre. Fibrinous exudation on surface of both lungs. Opaque
yellow fluid in pleural cavities. Spleen much eidarged, intensely hyperajmic, and of firm, liver-like
consistence. Liver enlarged and extremely hyperoemic, with very marked cloudy swelling at parts ;
a number of small yellow points like tubei'cles throughout the hepatic tissue. Kidneys verv
hyperEemic, and revealing on section minute hsemorrhagic foci, each with a greyish centre, situated
chiefly in the pyramids. Right supra-renal gland transformed into a dense yellow, cheesy-looking
mass by coagulation necrosis.
Bacterioscopic Examination. — Bacillus pestis in buboes, blond, lungs, spleen, liver, kidneys, and
suprarenals.
(Figs, 2, 3, 4, 12, and IG to 22.)
Case 25. — R.M., aged 12 Years.
Approximate Period of Incubation uncertain ; Case in household 16 Days previously.
Duration of Illness, llf. Days.
Post-mortem Examination, 28th September, 1900.
Purulent axillary and subclavicular buboes. Surgical drainage opening in left mammillary line
over second intercostal space, traversing the pectoralis major and minor towards the axilla. A mass
of purulent tissue, consisting of enlarged lymphatic glands and softened connective tissue, extending
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from axilla under pectoralis minor, the glands being partly softened and yellowish grey, partly firm
and granular, with dull areas of coagulation necrosis. Pectoralis minor and serratus anticus major
streaked with purulent infiltration. Abscess iu thymus gland, and purulent infiltration of anterior
mediastinum. Polyadenitis. Lobar and lobular pneumonia, with numerous well defined reddish-grey
necrotic areas about the size of a hazel nut, in both lungs ; fibrinous exudation on both pleural
surfaces. Myocardium pale yellowish-brown, friable, and opaque from cloudy swelling. Spleen
enlarged, the cut surface being smooth, the pulp firm, and the malpighian bodies dark brown. The
kidneys are of medium size, and the cortex in each is friable and opaque. Liver of medium size, pale
yellowish brown, and friable from cloudy swelling. Punotiform hfemorrhages in stomach.
Bacierioseopic Examination. — Bacillus pestis in buboes, blood, lungs, bile, and spleen. Staphy-
lococcus aureus in suppurating bubo, in blood, lungs, and spleen.
(Figs 5, 6, and 13.)
The presence of pneumonia in these two cases afforded the only illustrations
of involvement of the lungs. Moreover, the conditions were very different in each.
In Baby M., a hsemorrhagic broncho-pneumonia appeared, the consolidations being
distinguished by a peripheral zone of haemorrhage, and frequently also by a minute
yellow necrotic centre of firm consistence. In the case of R. M., on the other hand, a
mixed croupous and lobular pneumonia extensively involved both lungs. Large and
well-defined nodular necrotic consolidations were disseminated throughout the pul-
monary tissue. These appeared sharply defined in the intensely hyper^mic and
cedematous upper lobeS; and with less distinctness, in the midst of grey hepatisa-
tion, in the lower lobes (Figs. 5 and 6). A fibrinotxs exudation was manifest on
the pleural surfaces in both cases.
The buboes in the two cases, while displaying the same general characteristics
as those in the first class of cases, presented some points of special interest. The
multiple buboes on both sides of the neck of Baby M., involving the superficial and
deep cervical glands, pointed to the path of infection as having been hy the nose
and mouth (most probably at the time of birth), and this view receives further
support in the presence of the broncho-pneumonia. The purulent infiltration of
the tissues in the neighbourhood of the buboes in the case of R. M. had resulted
from mixed infection with staphylococcus, pyogenes aureus.
As regards the condition of the other internal organs of these two cases, the
most notable change was the pronounced cloudy swelling, especially of the heart.
In the right suprarenal capsule of Baby M.,this degenerative change had ultimated
in coagulation necrosis. The multiple metastatic foci in the liver and kidneys were
also a remarkable manifestation of the moi'bid process in this case (Figs. 3 and 4).,
Similar foci were also observed in one other case namely, (J.B. No. 1.), but only in
the kidneys. A similar condition was found in the liver of a mouse which died
on the sixth day after experimental inoculation.
Professor Zabolotny, of St. Petersburg, who was present at most of the post-
mortem examinations, and whose kindness and assistance during the epidemic I
have the greatest pleasure in acknowledging, informed me that he had frequently
observed these foci in the course of his work in connection with plague in various
countries.
III. — Chronic Bubonic Case, with Necrosis and Sloughing.
Case 1. — J.B., aged 60 Years.
Approximate Period of Incubation, 9 Days. Duration of Illness, J/S Days.
Post-mortem Examination, SSth September, 1900.
Right inguinal bubo, with indolent sloughing ulcer in skin. Under floor of ulcer a dense mass of
soft granular yellowish necrotic substance, like inspissated pus, extending upwards in the course of
the vessels under Poupart's ligament, and continuous with a chain of partitioned abscesses partly
filling the right iliac fossa, the right side of the pelvis, and impinging on the right wall of the bladder.
Purulent infiltration of psoas muscle upwards to lumbar vertebras. A sinus leads from the lower of
these abscesses downwards to discharge from a small opening in upper end of ulcer. Purulent
77
infiltration of the subcutaneous and deeper tissues half-way down the thigh. -^Glands in other regions
appear normal. Lungs hyperasmic and oedematous. Heart muscle pale and cloudy; fibrous
thickening of aortic and mitral curtains. Liver hyperjemic. Spleen enlarged and of firm consistence.
In both kidneys there are numerous small yellow points like tubercles visible in the cortex, A small
ulcer appears in the gastric mucous membrane near the pylorus.
BaaerioKConic Examination. — Bacillus pestis not recovered from bubo or organs. Colonies of
staphylococcus in periphery of glands of bubo.
(Fig. 7.)
This case is of special interest, in contrast with those already described, on
account of the long duration of illness, and the consequent modification of the bubo.
The whole of the bubonic tissue had undergone necrosis and was in process of
sloughing, while a number of large abscesses followed the course of the vessels
upwards into the pelvis. Extensive purulent infiltration also involved the sub-
cutaneous and intermuscular tissues of the thigh.
With the exception of the kidneys, the internal organs presented no features
calling for special reference. The small yellow foci observed in the kidneys have
already been referred to in connection with the case Baby M. They resembled
somewhat metastatic abscesses, but were of firm consistence, and unaccompanied
by any evidence of inflammation.
MICROSCOPICAL EXAMINATION OF THE FRESH TISSUES.
Preparations were made at the time of the post-mortem examination from the
glandular swellings. This was done by drawing the edge of a cover glass, charged
with material from the cut surface of the gland, lightly across the slide, so as to
make a thin uniform film. A series of film specimens was in like manner secured
from the blood and organs generally. The films were fixed with absolute alcohol,
and stained for about five minutes with carbol-thionin-blue, or for as many seconds
with carbol-fuchsin. Gram's method proved of great value as a control stain, inas-
much as the bacillus pestis characteristically failed to hold the stain by this method,
while other species, such as pneumococcus, staphylococcus, and streptococcus, if
present, were rendered prominent by retaining it.
In those preparations from buboes in the acute stage bacillus pestis was found
in great number, and in .what might be called its typical vegetative or normal
form — namely, a short thick bacillus with rounded ends, the ends staining deeply
in contrast with the faintly stained or colourless centre, and producing the picture
known as " polar staining " (Plate II.). The bacilli were generally evenly dis-
tributed throughout a thin film as isolated elements, while in the thicker films
they were often found heaped together in very great numbers.
In preparations from lesions of longer duration the bacilli showed a degenerative
tendency, losing the plump appearance, and becoming irregular in size, stunted or
elongated, ovoid, and finely globular (Fig. 9). The degree of staining at the same
time appeared less and less, until there was only a thin crescent at the position of
the polar protoplasm, or a faint marginal rim all round. Finally, bloated,
colourless forms could be seen, by intense staining of the specimen, forming great
areas, in which a comparatively small number of more recent forms were scattered.
An erroneous impression of the number of bacilli might thus at first sight be
obtained.
A mixed infection was very apparent in the films made from two cases (G. H.
and Mrs. M.), in which the bacillus pestis was found in association with the
pneumococcus. Figs. 9 and 10 show this mixed infection in the lung and bubo of
one of these cases.
Considerable interest attaches to the case in which the stage of suppuration ot
the bubo had been reached (Case D, Mrs. G.). Here no trace of the plague
bacillary forms could be obtained under the microscope, although there were
78
numerous round bodies and tadpole-like forms, which might be regarded as
involution forms of bacillus pestis, from the close resemblance to similar forms
obtained in artificial cultures, especially on gelatine. The duration of this case was
about 14 days, and the entire disappearance of the plague bacillus from the body
within this period is noteworthy.
In the case of J. B. (No. 1) it is not surprising that the bacillus pestis was not
obtained from the bubo, considering that the patient lived for fully six weeks.
The same evidence of the presence of degenerated forms was manifest however, and
the transition from the bacillary to the distorted form was quite traceable.
MICROSCOPICAL EXAMINATION OF THE TISSUES IN SECTION.
Sections for microscopical examination were made from specimens of the
organs and tissues of each case.
The tissues were fixed and hardened in absolute alcohol, and sections were
obtained by embedding in paraffin, according to the following method : — Selected
pieces were immersed for a few hours in fresh absolute alcohol, and then transferred
to cedar oil overnight, the bottle containing the oil being placed on the top of the
paraffin bath. Next morning the pieces were placed in soft paraffin (45° C), after
being freed of superfluous cedar oil by means of filter paper, and kept in the bath
for about three hours at a temperature of 53° C. The pieces were then transferred
to hard paraffin (52° C.) for about two hours, and finally embedded in fresh hard
paraffin.
The staining of the bacillus pestis in situ in the various organs and tissues
was frequently difficult to accomplish satisfactorily, on account of its feeble hold on
stains in the presence of decolourising agents. Various methods were tried, and
the following, in which carbol-thionin-blue and eosin were used as stain and
counterstain, was the one which gave the best results : — The sections were (1)
stained on the slide for five minutes with carbol-thionin-blue, rinsed in water to
get rid of excess of the stain, differentiated in water to which a few drops of acetic
acid had been added, and washed in water ; (2) counterstained with J per cent,
watery solution of eosin for 30 seconds, washed in water, dehydrated in absolute
alcohol, cleared in xylol, and mounted in Canada balsam.
The Bubo.
In the earlier stages of the glandular swelling the periglandular blood vessels
are found to be greatly engorged (Fig. 24). Extravasations of blood are also
numerous and extensive in the investing tissues of the glands. Thrombosis of the
periglandular vessels appears in the bubo of one of the cases (Mrs. M., No. 22).
The affected glands exhibit various conditions, depending apparently on the
duration and intensity of the morbid process — namely, (a) bacillary invasion of the
periphery of the gland only ; (h ) bacillary invasion of the entire gland, with great
congestion and haemorrhage ] (c) bacillary invasion and necrosis of the gland along
certain tracks; (cl) bacillary invasion and necrosis of the whole gland; and (e)
softening or suppuration, with entire disappearance of the bacilli.
(a) Bacillary invasion of the periphery of the gland only. — In several
instances it is found that bacillus pestis has become aggregated in great masses
in the periphery of the lymphatic glands, in what appears to have been a very
early stage in the formation of the bubo. In other respects the glands a2Dpear
fairly normal (Fig. 16). This tendency of the bacillus pestis to accumulate in
enormous numbers in the periphery of the gland is also seen in the bubo of a
plague-infected mouse.
79
(b) Bacillary invasion of the entire gland, ivith great congestion and
hcemorrhage. — In the more acute buboes congestion and haBmorrhage are the
outstanding features. A great engorgement of the blood vessels and a general
extravasation of blood — not uniformly, but in homogeneous areas and infiltrations
— are visible throughout the gland. The gland tissue, as such, has almost
entirely disappeared, and the section is more like that of a spongy vascular
tissue. Extending throughout the gland are also homogeneous masses and tracts
of plague bacilli. Their number is so great and their aggregation so close that
they completely obliterate all trace of gland structure. In the upper pai-t, and to
the right of Fig. 24, such a mass of bacilli is shown in the periphery of a bronchial
gland, the lighter parts in the dark mass being due to extra vasated blood. The
enormous numbers in which these bacilli pervade the affected tissues cannot but
be regarded ctS 9j special feature of the disease.
(c) Bacillary invasion and necrosis of the gland cdong certain tracts. —
Taking a gland which appears to the naked eye as only slightly affected, a
condition differing very materially from that just described is found. Although
the vessels are engorged, there is comparatively little or no haemorrhage.
Certain tracts of gland tissue invaded by plague bacilli have undergone necrosis.
The cellular necrosis exhibited in these tracts is a very striking feature. It is
seen in the various stages which mark coagulation necrosis — namely, swelling with
fine granulation of the cell protoplasm, disappearance of the nucleus, and, finally,
disappearance of the cell outline. It is notable that this necrosis appears to
have involved the bacilli themselves in like manner, for where it is most advanced
the bacilli have also become indistinct, and refuse to take the stain. The other
parts of the gland lying between these necrotic tracts are normal in appearance,
and free from bacillary invasion (Fig. 25).
(d) Bacillary invasion, and more or less complete necrosis of the whole
gland tissue. — This condition is evidenced to the naked eye by a greyish or
yellowish-grey appearance of parts of the gland or of the whole gland, or, when
much hasmorrhage is also present, by a mottled brownish red and grey. The
tissues of the gland have lost much of their outline, appearing more or less
homogeneous, and devoid of nuclear staining. The bacilli have almost disappeared,
and can only be seen in faintest outline. In marginal parts of the gland,
however, they are still to be found in distinct and characteristic swarms. The
walls of the blood vessels, in one case (Mrs. M.), are homogeneous, swollen and con-
voluted, and the larger vessels in many instances are filled with leucocytes. A
number of leucocytes also remain distinct throughout the dead tissue (Fig. 27).
As all these conditions could be found in a case in which the illness was only of
three days' duration, the entire disappearance of the bacillus pestis from the bubo
would presumably be a matter of a few days more. In this tendency to early
extinction of the bacillus pestis in a bubo rests the explanation of the negative
results sometimes obtained after exploratory puncture for purposes of diagnosis,
even in the end of the first week (see Dr. M'Clure's Report on Clinical Bacteriology
page 57), and also of the diminution or complete loss of infectivity which, as a rule,
distinguishes the discharge from a plague bubo.
(e) Softening or suppuration, with entire disapjyearcmce of the bacilli. — In
the case of Mrs. G. (Case D) the glands of the bubo had all undergone softening,
and resembled so many well-defined abscesses containing brownish viscid pus.
Sections from a less affected gland from the other groin show no trace of plague
bacilli ; but a considerable number of round bodies, varying greatly in size, are
readily detected. The large number of these bodies, and their resemblance to
similar bodies in old cultures, especially old gelatine cultures, of bacillus pestis,
indicate that they are bacilli which have undergone modification into the
characteristic " involution " form. Again, in the case of J. B. (Case No. 1), in which
some of the glands were soft and yellow, like inspissated pus, and others were in
the form of large abscesses (Fig. 7), the same bodies are found in even greater
number.
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Lungs.
The two cases of secondary pneumonia present very different conditions under
the microscope. In the case of Baby M. numerous small foci of condensation are
visible to the naked eye throughout the section. Under the microscope these are
found to be due to the occupation of groups of lung alveoli by colonies of plague
bacilli; the appearance presented bearing a remarkable resemblance to an artificial
coloured injection of the air spaces (Fig. 17). Each group of invaded alveoli marks
the distribution of a bronchiole. The central part of the invaded area is necrosed,
and in the peripheral part the alveoli are occupied by blood corpuscles. Very few
leucocytes are present. The pulmonary vessels generally are engorged with blood,
and the perivascular lymph channels and those of the pleura are occupied by
enormous numbers of plague bacilli (Fig. 18). In the case R M. the conditions
presented are those of croupous pneumonia. The lung alveoli are occupied by a
network of fibrin, and notably few cell elements are present. Plague bacilli are
scattered diffusely throughout the alveoli in great number. In the necrotic areas
the same general appearances are found, but with the additional evidence of
coagulation necrosis.
Liver.
The liver in the case of Baby M. shows focal accumulations of bacillus pestis
in the capillary vessels. On surveying the section under the low power, it is found
that these colonies or foci are very numerous, and are distributed almost uniformly
throughout the organ. In and around them is a small number of leucocytes (Figs.
21 and 22). The capillaries generally are greatly distended, and show compara-
tively few bacilli. The yellow foci mentioned in the post-mortem report, and
shown in Fig. 4, are essentially of the same structure, being composed simply of a
proportionately greater number of bacilli and leucocytes. Necrosis of the hepatic
cells in the vicinity of the nodules is not seen, and the hepatic cells actually
involved in the lesion have disappeared, apparently as the result of pressure. Fig.
23 shows the liver of a plague-infected mouse which died on the sixth day, and in
which a similar condition is observed. Here, however, the plague bacilli have
disappeared. Only a few are to be found in the part which is attached to the
ruptured vessel wall.
Spleen.
The microscopical examination of the spleen reveals the bacillus pestis
uniformly distributed in great numbers throughout the capillaries in the cases
of G. H. and Mrs. M., but extremely scanty in the cases of Baby M. and R. M.
A notable contrast is afforded by the spleen and the bubo, in the absence of
coagulation necrosis in the spleen, although the accumulation of pest bacilli may
be very great. In Fig. 26 the distribution of bacillus pestis throughout the splenic
tissue is shown, but only a comparatively small number of the bacilli are in focus.
Kidney.
An interesting condition is exhibited in the kidney of G. H. Bacillus pestis
is seen throughout the organ adhering closely to the intima of the capillaries, and
apparently passing through their walls into the perivascular tissue, in which
considerable accumulations of the bacilli frequently appear. Capillary vessels are
here and there obstructed by small groups of bacilli. Careful search fails to reveal
the presence of a single bacillus within the renal tubules.
In Fig. 19 a localised growth of bacillus pestis is shown in the kidney of
Baby M., and represents one of the " foci " observed post-mortem. The bacilli are
aggregated in great masses between the tubules within a certain area, and are
associated with a considerable amount of leucocyte infiltration of the part.
81
In the case of J. B. the yellow foci appear in small, well-defined subcapsular
areas in which tubular structure is to some extent retained. The tubules are,
however, distorted and distended, and a semblance to papilliform structure is
noticed here and there. They mostly show a lining of proliferating epithelium,
and many of the cells have been shed singly and in casts. A few spaces are
occupied bv granular contents composed of degenerated epithelium and red blood
corpuscles. No trace of B. pestis or other organism is found. The interstitial
tissue of the kidney is increased, and shows a large amount of round cell infiltra-
tion. Many of the glomeruli have undergone fibroid change.
Suprarenal Gland.
The microscopical examination of the necrosed suprarenal found in the case of
Baby M. shows the same focal developments of bacillus pestis as pertains in the
other organs of this case (Fig. 20). Only a thin rind of gland tissue just under the
fibrous capsule appears normal, the great mass of the parenchyma having under-
gone coagulation necrosis. In the suprarenal of G. H. the bacillus pestis is
uniformly and sparsely distributed in the blood vessels, but otherwise the gland
appears normal.
CULTURE EXPERIMENTS.
Cultures were obtained by the inoculation of agar at the time of the 'post-
mortem examination. Material from the bubo, the blood, and the viscera generally
waG taken by means of a Pasteur pipette, and immediately implanted on agar
surfaces in test tubes or m plates. The latter had the comparative advantage that
they afforded a larger surface for the spread of the infective material, and also
that the growth could be more readily examined under the microscope. It also
permitted of easy separation of the species in the cases of mixed infection.
No growth became visible in the medium until the second day. A crop of
minute greyish colonies then appeared. On closer inspection with a lens, and by
transmitted light, these showed a greyish white centre and a translucent uneven
margin. Under a low power an average colony looked finely granular, with an
opaque brown centre, a broad translucent marginal zone, and a very irregularly
indented edge. With the high power the smallest colonies were very ti'anslucent
thin films, slightly more dense in the centre, and marked all over by a veiy fine
mosaic pattern ; while larger colonies had the same general appearance as under
the low power. The features thus exhibited in the smallest colonies were remark-
ably characteristic.
After this earliest appearance the growth gradually became more and more
pronounced, and attained a maximum in about ten days. With increase in size the
colonies became white and opaque in the centre, and, when numerous and closely
set, produced an opaque finely granular surface, which has been well likened to the
appearance of a bit of ground glass (Fig. 28). At the same time numerous colonies
of larger size appeared here and there, dense, glistening, waxy white with reflected
light, and brownish yellow with transmitted light. These large or " giant colonies "
when sufiiciently isolated showed very characteristic outlines, namely, a raised
yellowish dome-like centre and a clear crenated border.
In cultures in which the colonies were well isolated from one another, each
colony attained a size of 1 to 4 mm., and presented the same general characteristics
as the giant colonies, but with the border exaggerated and characteristically crimped
or knobbed. This appearance, which might be regarded as the impress of full
development, persisted afterwards as the distinguishing feature of the growth, even
after it had become dried.
Another very marked characteristic of the growths was their viscidity, which
manifested itself on attempting to remove colonies, especially when confluent, by
means of the platinum wire.
82
The microscopic appearances of the bacillus in cultures were as follows : —
When an agar culture was examined between 24 and 48 hours, the colonies yielded a
small squat bacillus,^ only slightly longer than broad, and rounded in the ends (Fig. 30).
In some cultures longer forms were met with, and so irregular were the elements
in this respect as to suggest a mixed growth. In these latter cultures the longer
bacilli were often slightly curved and clubbed, resembling in outline somewhat the
the bacillus diphtheriEe, with one of the ends often squared or fractured looking.
This square-cut end was often exhibited in specimens from the fresh tissues, and
appeared to mark recent division through the clear centre of the parent bacillus.
In older agar cultures the polymorphism of the bacillus was further and still
more remarkably exhibited by so-called " involution forms." A certain minority of
the bacilli was seen to have become greatly enlarged, and capable of intense
staining. In this enlargement they retained the bacillary form, or assumed a
globular, piriform, or knobbed shape (Fig. 33). Forms like fragments of mycelial
threads were also frequently seen. In the midst of these grotesque forms the great
majority of the bacilli could still be seen in faint outline degenerated and unstained-
These " involution forms " were obtained from an ordinary agar culture at the end
of six weeks. They were not, however, uniformly so obtainable in the cultures from
all the cases. In many old cultures on ordinary agar, it was commoner to find this
involutionary change much less pronounced, as shown on Fig. 34; the modification
of form not being so extreme, and the number of elements undergoing involution
not so great.
Solidified blood serum yielded an abundant yellowish-white glistening growth
in well marked colonies, or in ridges, having the same general outline as the
growth on agar, namely, a raised centre sloping to a flattened, crimped, or crenated
border.
On gelatine very copious growths were obtained. The colonies also closely
resembled those on agar, but were whiter, being silvery grey with transmitted
light, and faintly grey or dewdrop-like with reflected light. There was nothing
specially notable in stab cultures, except the tendency to frond-like expansions on
the surface of the gelatine. No liquefaction took place.
On serum and on gelatine the bacillus presented the same morphological
characters as on agar. It was observed that the involution forms on serum were
mostly elongated, while those on gelatine were mostly globular and extremely
varied in size.
In ordinary bouillon sub-cultures were made as control experiments. It was
found that the bacillus isolated from each case gave a characteristic growth of
chain forms. The growth appeared as a creamy-white deposit in a clear medium.
Sometimes it also formed a fine whitish dusting on the sides of the tubes, and
sometimes the fluid was at first rendered turbid, to become ultimately clear
however. This tendency to cause turbidity of the medium seemed to belong to
certain cultures.
The chains of bacilli obtained from these cultures were composed of four to six
elements as a rule, and are shown in Fig. 31 as they appeared at the end of forty-
eight hours. When the same culture was examined at the end of four days, the
individual elements forming the chains had become rounded and swollen, and many
of them degenerated so that they would not stain, as may be seen in Fig. 32.
INOCULATION EXPERIMENTS.
Inoculation experiments were undertaken only for the purpose of diagnosis,
and reference may be made to several which were attended by results of exceptional
nature.
^ The bacillus was readily stained by ordinary aniline dyes, and as readily decolourised by the
Gram method.
83
The animals used were mice. Two of these animals were inoculated from the
bubo of G. H. (Case No. 18), in which there was a mixed infection. Mouse I., inocu-
lated subcutaneously, died in 36 hours Avithout glandular enlargement, and only the
pneumococcus was found under the microscope, and in cultures from the blood and
spleen. Mouse II. had the infected material applied to the nostrils, and died in 48
hours with typical lesions of plague in the lungs and lymphatic glands, the bacillus
being obtained in pure culture. The value of this method of inoculation, as a
control experiment, was thus corroborated.
Material from the case of R. M. (No. 25) produced results of exceptional
interest. Mouse VII. was inoculated subcutaneously from the axillary bubo (which
was much necrosed) and survived six days — the inguinal and axillary glands appear-
ing as yellowish-white bubonic swellings, and the liver being studded throughout
with minute yellow foci. Only a few bacilli were found in the blood. The first
sub-culture from the same bubo proved fatal to Mouse XIV. in three days. On the
other hand. Mouse VIII., inoculated from the pneumonic lung of this case, lived for 27
days. After ten days, nervous symptoms appeared in the form of twitchings of the
head backwards, some paralysis of the hind legs, and a tendency on the part of the
animal to go round and round, as if chasing its tail. Those symptoms were present
for about a fortnight, but were only very marked when the animal was disturbed,
and were gradually disappearing up to the time of death. No lesions were found
on post-mortem examination, and no bacilli developed in cultures.
Mouse XII., inoculated subcutaneously from the retroperitoneal bubo of Mrs. M.
(Case No. 22), died in two days.
Mouse XIII., inoculated from the second suh-culture obtained from the
cervical bubo of Baby M. (Case No. 28), lived for 15 days.
A marked contrast with the latter experiment was seen in Mouse XL, which
succumbed in three days after subcutaneous inoculation with the third siih-cidture
from the bubo of G. H.
These few experiments serve to illustrate a remarkable variation in the degree
of virulence of the virus under the different conditions presented.
MODE OF INFECTION.
The study of the macroscopic and microscopic appearances in these seven
cases does not permit of the expression of a definite opinion as to the mode of
infection or the path of entrance of the plague bacillus into the body. At the
same time certain considerations have been noted as bearing on this important
question, and demand a passing reference. There is a very prevalent opinion that
the virus gains entrance through some solution of continuity in the skin in a large
number of cases, and that this is the common mode of infection in bubonic cases.
That the infection can be acquired in this way there is no reason to doubt, as
many painful instances of accidental inoculation amply testify, but that it is the
common mode of infection is far from being conclusively proved. In the cases just
described, which were all bubonic, no skin lesion was found at the time of the
post-mortem examination which might have served as the point of entrance,
although it is possible that a trivial woimd, quite sufficient for this purpose, might
have entirely disappeared by the time of the patient's death.
The preponderance of inguinal buboes is quite in harmony with what has been
found in other epidemics, and this lesion would appear to be altogether too
regularly fi:equent in its incidence to admit of explanation on the ground of
accidental inoculation through the skin of the lower extremity. One would expect
the primary bubo to be as common, if not commoner, in the axilla did the bacillus
usually gain entrance through the skin. A peculiarity of the bacillus exhibited in
3. number of specimens is of special interest in this connection, namely, its tendency
84
to pass out of the blood stream. In the capillary vessels the bacillus is distributed
along the internal surface of the vessels, and is frequently seen to have passed
through their walls into the perivascular spaces. In this fact most probably lies
the explanation of the relative frequency of the lesion in the lymphatic glands.
There is reason to believe that in plague, as in some other infective diseases,
infection of the blood takes place during the period of incubation, but that the
bacillus pestis during this period tends to pass out of the blood vessels into
lymph channels in the majority of cases, to be ultimately arrested in a particular
chain of glands, most commonly the inguinal, and give rise to the characteristic
bubo.
In one of the cases (Baby M.), the evidence points to infection by the nostrils
and mouth at the time of birth. Here, however, it will be apparent that the
process of infection was more like that of an experimental inoculation than infection
under ordinary circumstances.
In a few of the cases, at the beginning of the epidemic, the symptoms were
chiefly gastro-intestinal, and pointed to infection by ingesta. but no corroborative
evidence of this was elicited.
BACTERIOLOGICAL DIAGNOSIS.
The diagnosis of plague, in its earlier stages at least, can readily be placed
beyond doubt by bacteriological methods. The application of these methods was
therefore of the utmost importance at the commencement of the epidemic, and in
connection with doubtful cases of glandular enlargement and pneumonia. The
procedure was determined by the nature of the lesion, the material for examination
having to be obtained from the bubo, the blood, or the sputum, as the case
might be.
The successful puncture by means of a hypodermic needle of small painful
glandular swellings (for it was chiefly in connection with these that any doubt
existed) and the withdrawal of some fluid for examination was a matter of con-
siderable difficulty, especially in children, and more especially amidst the squalor
of the patient's surroundings. Further, the time required for bacteriological proof
was apt to run into several days, if animal experiments were required. The
application of the bacteriological test to doubtful cases in their own homes was
therefore not found to be of much practical value from an administrative point of
view, and these cases were accordingly removed to hospital at once for observation.
The supposititious danger of infecting surrounding tissues, or even of causing
a general blood infection, and so changing a simple bubonic case into one of
septicaemia, by puncture of the bubo, was always kept in view, but in no case did
any local or general disturbance follow to give it any credence. The operation was
accomplished in every instance without any apparent harmful effect.
A number of patients with ordinary inflammatory swellings were brought
under observation by virtue of the general suspicion extant regarding all glandular
lesions. Clinically but little doubt remained as to the true nature of these cases,
and bacteriological examination served at once to remove any uncertainty as to the
diagnosis. In this connection also the following case has a special interest of its
own : — A boy, about ten years of age, died somewhat suddenly at home, under
circumstances of a suspicious nature, in view of the presence of plague in the city.
The probability of plague was further increased by the history of the illness and
the presence of enlarged lymphatic glands. The body was removed to Belvidere
Hospital for post-mortem examination, with the result that an acute suppurative
tonsillitis was found associated with considerable enlargement of the deep cervical
glands and tumefaction of the lymphatic glands generally. The lymphoid tissues
generally were in a state of extreme hyperplasia. No plague bacilli were discovered
85
in the blood or organs. A general tumefaction of the lymphatic glands was also
observed in two fatal cases of broncho-pneumonia, which came under suspicion by
reason of their occurrence in a tenement from which a case of plague had been
removed.
A case of pneumonia which was removed from the plague-infected area to
one of the general hospitals gave rise to the suspicion of plague. Bacterioscopic
examination showed pneumococcal infection only. This was one of a number
of pneumonic cases that came under observation, and required verification by
bacteriological methods.
An equipment was provided for the use of medical members of the staff. It
consisted of a sterilised hypodermic syringe and needle placed in a sterilised glass
tube, which in turn was placed within a box of convenient size. The syringe and
needle, after being charged with fluid from the suspected swelling, were replaced
in the glass tube, and conveyed at once to the laboratory. By these means
personal risk to the physician and others was reduced to a minimum, and the
morbid material was received in a condition to be at once subjected to examination
by the microscope, by cultures, and by inoculation experiments.
PKECAUTIONS OBSERVED IN CONNECTION WITH POST-MORTEM
EXAMINATIONS AND INOCULATION EXPERIMENTS.
At post-mortem examinations the utmost precautions were observed to prevent
any spread of infection. The sheet which had enveloped the body was at once
burned. Fluids from the body were received in vessels containing perchloride of
mercury solution (1 : 500) before being run into the drain. All sponges were burned
immediately after use. The body was thoroughly washed with perchloride solution,
and after its removal in fresh dressing, the instruments, the table, and the floor
were thoroughly disinfected. The Pathologists' hands were protected by carbolised
vaseline and thin indiarubber gloves.
Film preparations on slides from the fresh tissues, for microscopic examination,
were fixed by completely immersing the glass for three minutes in absolute alcohol.
This had the advantage over the heat of the flame as a fixing agent, that it secured
at the same time complete sterilization of the whole film. Specimens were washed
in a fine stream of water over a basin containing perchloride of mercury solution
(1 : 1000) and dried with small squares of cloth, which were afterwards destroyed by
burning.
The animals experimentally inoculated with plague material or cultures for the
purpose of diagnosis were kept under conditions which aimed at preventing access
of rats, mice, or flies. Mice were used in preference to guinea-pigs as giving residts
more rapidly, and as being more easily and safely accommodated.
The mice were kept in ordinary museum jars provided with a tight-fitting lid
of finely perforated zinc. Accommodation for guinea-pigs on similar lines in large
jars was found to be quite unsuitable, and was at once abandoned for a large glass
cylinder, open at both ends. This was supported over a disinfectant in a deep
tray, while in the bottom was placed a raised perforated zinc platform, and on the
top a tight-fitting perforated zinc lid. Such a cylinder had the double advantage
of permitting a constant circulation of air and immediate disinfection ,of the
excreta. At first the jars containing the animals were placed in a large tin case,
24 inches by 24 inches by 30 inches, provided with a finely perforated zinc lid,
with the object of still further guarding against the access of other animals, but
with the completion of a special room (which was actually in process of construction
when the outbreak took place) the use of the metal case was no longer found to be
necessary,
86
The room which has been set apart for the reception of plague-infected
animals is 13 feet by 9 feet by 8|- feet, with concrete floor. It is heated by a gas
stove, is well lighted, and has cross ventilation by the windows.
The dissection of the animals which succumbed to the disease was carried out
so that no infective material should escape destruction or sterilisation. The skin
of the animals was thoroughly soaked with lysol. Mice were fixed on cardboard,
and on completion of the examination the carcase and cardboard were cremated
together. Guinea-pigs were likewise cremated after examination. The board on
which they were placed for examination rested on the bottom of a deep enamelled
tray, and was steeped over night in 5 per cent, carbolic solution.
EXAMINATION OF RATS IN RELATION TO THE OUTBREAK OF
PLAGUE IN GLASGOW.
The part played by rats in disseminating the infection of plague is still involved
in much uncertainty. The literature of the subject clearly testifies that a number
of plague epidemics have been immediately preceded by or intimately associated with
the disease in rats. In some of these epidemics there seems to be no doubt that
the rodents were the means of diffusing the infection and transmitting it to man.
On the other hand, there have been epidemics in which the rat has not appeared
to play any part, and some also in which a great mortality amongst the rats, even
in the dwellings of the people, was not accompanied by a correspondingly serious
■outbreak of human plague. It would appear, therefore, that as a carrier of infection
from port to port, and as a distributor of infection on land, the rat is presumably an
important factor; but the assumption that it necessarily plays a part in dis-
seminating infection during an epidemic of human plague is not warranted by facts.
In Glasgow, whatever the original source of the infection may have been, there
was no evidence that rats played any part in carrying it amongst those who were
attacked by the disease. From the end of August till the middle of November,
236 rats were caught within the plague area — mostly in the neighbourhood of
infected houses — and no trace of the disease was discovered in any of them.
Further, no exceptional mortality or migration was noticed amongst the rats in
this or any other part of the city, either before, during, or after the epidemic. A
continual vigilance has been exercised by the sanitary and cleansing staff's for
evidence of any unusual disease or mortality among the rats, and the additional
number of 124 was submitted for examination from all parts of the town during
the winter. In the great majority it was found that death had taken place as
the result of violence, while in no instance was there any sign of plague.
PLATE I.
PLAGUE— ILLUSTRATIONS OF MORBID ANATOMY.
DESCRIPTION OF PLATE I.
Fig. 1. — Inguinal bubo in longitudinal section, composed of one large and several smaller glands.
Large gland haemorrhagic and necrotic. Surrounding tissues infiltrated with blood.
Formalin. Natural size. (Case — G. H. No, 18.)
Fig 2. — Cervical buboes of infant in longitudinal and transverse section, the darker rounded areas in
figures being congested, hBemorrliagic, and partly necrosed glands. Formalin. Natural
size. (Case— Baby M. No. 28. )
Fig 3. — Kidneys of infant, showing hsgmorrhage foci in the pyramids and hyperaemia. One Suprarenal
Capsule shown, altered by coagulation necrosis and haemorrhage. Formalin. Natuiul
size. (Case— Baby M. No. 28.)
Fig. 4. — Liver of infant. Transverse section, presenting a number of small plague tubercles (the
white circular points from 0'5 to 3 mm. in diameter), and very marked cloudy swelling
(the greyish hazy areas).. Formalin. Natural size. (Case — Baby M. No. 28.)
Fig. 5.' — Right lung, posterior half, showing large areas of necrosis (white) in midst of pneumonic
tissue. To the right is shown a mass of enlarged glands which lay in fi'ont of the trachea
and impinged on the pericardium^ Formalin, -fths natural size. (Case — R. M. No. 25.)
Fig. 6. — Left lung, posterior portion, showing pneumonic consolidation of the lower lobe, with
extensive necrosis (the whiter areas). Lobular consolidation, with some necrosis in
upper lobe. Alcohol, -fths natural size. (Case — R. M. No. 25. )
Fig. 7. — Right inguinal bubo. Specimen represents mass of tissue from Scarpa's triangle to internal
iliac artery. Under the skin (on left of figure) is shown a great mass of necrotic gland
tissue. Towards the artery (on the right) is the i-ounded contour of a large abscess,
impinging on the bladder wall — a part of which is shown below. Alcohol, -l-rd natural
size. (Case — J. B. No. 1,)
Plate I.
7.
PLATE II.
PLAGUE— FILM PREPARATIONS FROM FRESH TISSUES.
DESCRIPTION OF PLATE II.
Fig. 8. — Bacillus pestis from inguinal bubo. vShows the bacillus in process of degeneration and
extinction. (Great numbers of degenerated, unstained, bacilli occupied the field, but
their forms are scarcely visible in the picture.) Gentian- violet. x 1000. (Case —
G. H. No. 18.)
Fig. 9. — Bacillus pestis, pneumococcus and streptococcus from lung. A distinct halo or capsule is
shown by some of the plague bacilli in lower part of figure. Blood corpuscles appear
vacuolated owing to imperfect fixation, Carbol-fuchsin. x 1000. (Case — Mrs. M.
No. 22.)
Fig. 10. — Bacillus pestis and pneumococcus from retro-peritoueal bubo, to show mixed infection.
Carbol-fuchsin. x 1000. (Case— Mrs. M. No. 22.)
Fig. 11. — Bacillus pestis from spleen. Gentian-violet. x 1000. (Case — Mrs. M. No. 22.)
Fig. 12. — Bacillus pestis from cervical bubo of infant. A pure infection ; bacilli in great number.
Carbol-thionin-blue. x 1000. (Case— Baby M. No. 28.)
Fig. 13. — Bacillus pestis from pneumonic lung. Carbol-fuchsin. x 1000. (Case — R. M. No, 25.)
Fig. 14. —Bacillus pestis from spleen of infected mouse, showing the bacillus in very typical form and
in active proliferation. Carbol-fuchsin. x 1000.
Fig. 15. — Bacillus pestis in blood of infected mouse. Carbol-fuchsin. x 1000.
Plate II.
PLATE III.
PLAGUE— MICROSCOPICAL ILLUSTRATIONS OF MORBID ANATOMY,
DESCRIPTION OF PLATE III.
Fig. 16. — Cervical bubo, showing several lymphatic glands with plague bacilli massed in the periphery
of each gland in enormous numbers. Carbol-thionin-blue and Eosin. x 60. (Case —
BabyM. No. 28.)
Fig. 17. — Lung, showing an area of alveoli (in the distribution of a bronchiole) occupied by dense
masses of B. pestis (black in figure). The central portion has undergone necrosis.
Carbol-thionin-blue. x 60. (Case— Baby M. No. 28.)
Fig. 18. — Lung, showing a large vessel with its perivascular spaces occupied by B. pestis. Carbol-
thionin-blue and Eosin. x 60. (Case— Baby M. No. 28. )
Fig. 19. — Kidney, showing a portion of the cortex in which B. pestis has developed between the
tubules in great masses, and leucocyte infiltration in an early stage. Carbol-thionin-
blue and Eosin. X 100. (Case— Baby M. No. 28.)
Fig. 20. —Suprarenal gland, showing part of fibrous capsule (at top of figure), masses of B. pestis in
the cortex, and coagulation necrosis of the deeper tissue as evidenced by disappearance
of neuclei. Carbol thionin-blue. x 60. (Case — BabyM. No. 28.)
Fig. 21. — Liver, showing the distribution in the organ of small isolated groups of B. pestis (the black
patches in right half of figure) Great distension of vascular system. Carbol-thionin-
blue and Eosin. X 60. (Case— Baby M. No. 28.)
Plate III.
PLATE IV.
PLAGUE— MICROSCOPICAL ILLUSTRATIONS OF MORBID ANATOMY.
DESCRIPTION OF PLATE IV.
Fig. 22. — Liver. Same section as in Fig 22, showing, under a higher power, one of the bacillary foci
with commencing aggregation of leucocytes. Carbol-thionin-blue and Eosin. x 250.
(Case— Baby M. No. 28.)
Fig. 23. — Liver of plague-infected mouse (which died on sixth day), for comparison with Fig. 23.
The metastatic process is more advanced, showing abscess formation and partial necrosis,
and the disappearance of the bacilli. The abscess has extended through the wall of an
intralobular vein. Carbol-thionin-blue and Eosin. x 250.
Fig. 24. — Margin of bronchial gland, showing the fibrous capsule, with three greatly distended blood-
vessels, and a small portion of the periphery of the gland occupied by bacilli in almost
homogeneous mass (black in figure). The darker parts in the capsule are also due to
bacillary invasion. Carbol-thionin-blue and Eosin. x 60. (Case — G. H. No. 18.)
Fig. 25, — Right inguinal gland (which was only slightly enlarged). Right half of field shovi s a tract of
necrosis, associated with invasion of B. pestis. Left half represents normal tissue free
from bacilli. Carbol-thionin-blue and Eosin. x 1000. (Case — G. H. No. 18.)
Fig. 26. — Spleen, showing the distribution of B. pestis throughout the tissue. Only a comparative!}'
small number of the bacilli in focus. Carbol-thionin-blue and Eosin. x 450. (Case —
G. H. No. 18.)
Fig. 27. — Retroperitoneal bubo, showing almost complete necrosis of the tissues. A large vessel in
the middle of the field is filled with leucocytes, and a few leucocytes are scattered
throughout the field. The darker shading in the figure indicates the presence of enormous
numbers of plague bacilli, x 60. (Case— Mrs. M. No. 22.)
Plate IV.
PLATE V.
PLAGUE— BACILLUS PESTIS IN CULTURE.
DESCRIPTION OF PLATE V.
Fig. 28. — Culture of B. pestis on agar. Colonies very numerous and small. (Case — R. M. No. 25.)
Fig. 29. — Mixed growth of B, pestis and pneumococcus on agar. The plague colonies, being few in
number, have attained a large size. The pneumococcus colonies are small, and only just
visible. (Case— G. H. No. 18.)
Fig. 30. — Bacillus pestis. Culture on agar after twenty -four hours. Carbol - fuschin. x 1000.
(Case— G. H. No. 18.)
Fig. 31. — Bacillus pestis in chains. Culture in bouillon after forty-eight hours. Carbol-fuschin.
X 1000. (Case = R. M. No. 25.)
Fig. 32. — Bacillus pestis in chains. Culture in bouillon after four days. Bacilli swollen, and many
of them degenerated, so that they do not take the stain well. Carbol-fuschin. x 1000.
(Case— R. M. No. 25.)
Fig. 33. — Bacillus pestis. Involution forms from a six weeks old culture on ordinary agar. A faint
groundwork is formed of degenerate unstained bacilli. Carbol - fuschin. x 1000.
(Case— R. M. No. 25.)
Fig. 34. — Bacillus pestis from old agar culture, to show the common appearance presented by old
cultures, x 1000. (Case— R. M, No. 25.)
Plate V.
33.
34.
1*^
CORPORATION OF GLASGOW.
CENSUS, 1901.
REPORT
ON
fiLASGOW; ITS SANITARY DISTRICTS AND MUNICIPAL WARDS.
BY
A. K. CHALMERS, M.D.,
Medical Officer of Health.
GLASGOW:
PRINTED BY ROBERT ANDERSON, 142 WEST NILE STREET.
CONTENTS. "
PAGE
Prefatory Note, 5
Population, 7
Rate of Increase in Several Periods, _ . . _ _ 7
Institutional Population, ------ - 8
Shipping Population, - - - - - - - 10
Age and Sex Distribution, - - - - - - 11
Comparison of Natural Increase in each Sex with Census Increase, - 12
Proportion of each Sex Living at Several Age Periods, - - - 13
Proportion of Population Born in Ireland, - - - - 14
Housing, 14
Number and Rate of Increase, - - - - - - 14
The Size of the Average House and the Average Number of its Occupants, 15
The Average House of Glasgow and other Towns in Scotland compared, - 16
Grouping of Population in Houses of various sizes, - - - 17
One- Apartment Houses, Old Glasgow, 1891 and 1901, - - - 18
Definition of a House for Sanitary and Census purposes, contrasted, - 19
" Farmed-out " Houses, - - - - - - - 20
Question of Overcrow'ding, ' - - -" - - 21
How far can the condition in Scotland and England be compared, - 21
Average Cubic Space per House in Glasgow in old and recently erected
Houses, - - - - - - - - 22
Sanitary Divisions of the City, 24
Intercensal Changes of Population and in House Accommodation, - 25
Question of Pressure in One and Two Apartment Houses in some
Districts, and the Cause thereof, - - - - - 26
Empty Houses, -------- 29
Formula for Calculating the Annual Increase, 19011911, - - 30
Average P^entals, -------- 30
Glasgow's Outer Ring, ----- - 31
Question of Sub-Dividing the Municipal W^vkds as a Substitute for
the Present Sanitary Districts, - - - - - 31
Index to Tables in Appendix —
SANITARY DISTRICTS.
Table I. — Comparative Statement of Population, Houses (Inhabited and
Empty), windowed rooms, persons per aci'e, per house, and per room,
and percentage of Irish-born, at the Census periods 1891 and 1901 in
the City and Sanitary Districts thereof, - - - - 38
4
Table II. — Age and Sex of the Population, distinguishing Institutions and page
Shipping, also number of Irish-born, in the City and Sanitai-y
Districts, ........ 40
Table III. — Age and Sex of the Inmates of each Institution within the
Sanitary Districts of the City, also number of windowed rooms, and
number of Irish-born therein, - - ... 44
Table IV. — Proportion per cent, of each Sex living at various periods of
life of the Total Population (exclusive of the inmates of Institutions
and Shipping) in each Sanitary District and in the City, and of the'
total inmates of Institutions and Shipping, - - - . 48
Table V. — Inhabitants grouped according to the size of their houses, and
also the number of windowed rooms, in the City and Sanitary
Districts, - ... . . . . 50
Table VI. — Proportion per cent, of Houses of various sizes and of the
Total Population dwelling in them in the City and Sanitary Districts, 5 1
Table VII. — Average number of Inmates per House of each size and of
all sizes, also percentage of Empty Houses, in the City and Sanitary
Districts, - - - - - - - - 52
MUNICIPAL WARDS.
Table VIII. — Statement of Acreage, Population, Hoiises (Inhabited and
Empty), windowed rooms, persons per acre, per house, and per room,
percentage of Irish-born, in the City and Municipal Wards thereof, - 53
Table IX. — Age and Sex of the Population, distinguishing Institutions
and Shipping, also number of Irish-born, in the City and Municipal
Wards, 54
Table X. — Proportion per cent, of each Sex living at various periods of
life of the Total Population (exclusive of the inmates of Institutions
and Shipping) in each Municipal Ward and in the City, and of the
Total Inmates of Institutions and Shipping, - - - - 58
Table XI. — Inmates of each Institution within the Municipal Wards of
the City, also number of windowed rooms and number of Irish-born
therein, go
Table XII. — Inhabitants grouped according to the size of their houses,
and also the number of windowed rooms, in the City and Mxmicipal
Wards, - - - - - - - - 61
Table XIII. — Proportion per cent, of Houses of various sizes and of the
Total Population dwelling in them in the City and Municipal Wards, 62
Table XIV. — Average number of Inmates per House of each size and of
all sizes, also percentage of Empty Houses, in the City and Municipal „
Wards, - - - - - - - - 63-
Table XV. — Relation of present Sanitary Districts to the Municipal
Wards of the City, - - - - - - - 64
Table XVI. — Number of Houses for the erection of which authority has
been granted by the Dean of Guild Court during each year from 1st
September, 1891, to 31st August, 1901, - ... 65
PEEFATORY NOTE.
Througli the courtesy of the Registrar General, and with the approval
of the Secretary for Scotland, the facilities which had been granted to the
Medical Officer of Health for the City in 1871, 1881, and 1891, were renewed
on the occasion of the recent Census ; but the altered requirements of the
Census (Great Britain) Act of 1900, and, more especially, the provision contained
in Section 9 thereof, led to an alteration in the method by which the extraction
of the details which are dealt with in the following pages was accomplished-
This occasioned only an unimportant delay in obtaining the information, but
it implied the prosecution of the work of extracting in Edinburgh, when the
books were in the possession of the Registrar-General, instead of as formerly while
they were still here in the custody of the Town-Clerk. It was thus necessary
to obtain the use of suitable premises in Edinburgh in which the work could
be done, and Sir James D. Marwick, Town-Clerk, whose courteous and continued
effort to obtain the requisite facilities and to further the progress of the
work I desire most heartily and thankfully to acknowledge, brought our needs
before Mr. Hunter, Town-Clerk, Edinburgh, through whose kindly interest a large
hall, attached to the Collector's Office there, was placed at our disposal.
I also desire to acknowledge the cordial assistance rendered by Mr. Gunn,
Collector, and his fellow officials, in connection with the preliminary arrange-
ments and during the progress of the work.
A staff of 37 clerks was thereafter employed ; the work of extracting was
begun on 18th July and finished on 27th July.
As on the occasion of the former Census, this was carried on under the
■direct personal superintendence of Mr. Elborn, Statistical Clerk to the
Department here.
In connection with a suggestion to reconstitute the Sanitary Districts
within the Municipal Wards, Tables have been prepared which for the first
time contain details of the Housing and Age Distribution of the population
in these latter.
A. K. CHALMERS,
Medical Officer of Health.
Sanitary Chambers,
Glasuow, January, 1902.
CENSUS 1901— GLASGOW.
POPULATION.
At the Census on the night of Sunday, 31st March, 1901, the
population of the City of Glasgow numbered 761,712.* The area of the City-
extends to 12,681 acres; the number of persons per acre is 60.f At the Census
on 5th April, 1891, the population numbered 658,073, of which 565,710 were
resident in Old Glasgow and 92,363 in the districts added to the City in the
following November.
The increase during the present decade amounts, therefore, to 103,639 persons,
and represents a rate equal to 15*75 per cent. The extent and source of this are
alike interesting. Numerically it is almost twice that of 1881-91, and four times
that of 1871-81. During the decade 1861-71 the increase was at the rate of 21-64
per cent., in 1871-81 it fell to 4 per cent., while during 1881-91 it was 10 62 per
cent. But the natural increment alone, i.e., the excess of births over deaths during
1861-71 was equal to an increase of 11-5 per cent, on the 1861 population, and
although this was maintained at a fractionally higher rate, viz., 11-7 per cent.,
during 1871-81, the actual increase at the Census of 1881 amounted only to 4 per
cent, on the 1871 population, while during 1881-91 the actual increase fell short
by 2"1 of the rate per cent, which the excess of births over deaths represented.
The actual increase represents the balance between births plus immigrants on the
one hand and deaths plus emigrants on the other, so that in the period 1871 to
1891 the City was losing a considerable portion of its natural growth through
emigration, or (what more correctly describes the actual movement) through the
overflow of its excess population into the surrounding districts — an artificial
restriction on the growth of its population which the extension of the boundaries
in 1891 has removed.
The following Table has been compiled to show this : —
Census Period.
Births.
Deaths.
Difference
representing
Natural Increase.
Census
Increase.
1861-71,
178,582
132,260
46,522
87,532
1871-81,
200,766
143,116
57,650
19,674
1881-91 (Old Glasgow),
196,767
131,446
65,321
54,295
1892-1901$ (Greater Glasgow),
218,269
142,974
75,295
103,639
* The Registrar-G-eneral gives 761,665 in his preliminary Census Tables, but until every entry
has beeo scrutinised and verified, discrepancies will exist between summaries from different sources, and
the difference of 47 here shown will introduce no error of material value.
+ At the Census of 1891 Glasgow contained 6,111 acres, and its density was 93 persons per acre ;
the extension in the following November added 5.750 acres and 92,363 persons, reducing the density to
56. In 1896 Bellahouston Park and district, containing 450 acres, with a population in 1891 of
510, was annexed ; and in 1899 Richmond Park and district, on the south side of the Clyde, and the
districts of Provanmill and Blackhill, on the north, with an acreage of 370 and a population in 1891 of
385, were annexed.
X The details for April-December, 1891, are not available. (See text.)
8
The figures for the decade just closed cannot be stated with precision
because the births and deaths in the added districts during the last nine months
of 1891 are not readily available. In the Table these are given from 1st
January, 1892, to 31st March, 1901, and show an excess of births over deaths
of 75,295. Assuming a rate for both births and deaths to have obtained during
the nine months of 1891 for which the records are not available similar to that
which obtained throughout the remainder of the decade, we shall only slightly
overstate the actual excess of births at 81,405, which leaves 22,234 of the Census
increase to be accounted for by excess of immigration over emigration during the
whole period. We shall see later in what proportion males and females respectively
contribute to this, but for the present it may be observed that the proportion
which the natural increment bears to the total increase in the past decade is 78
per cent, as compared with 53 per cent, during 1861-71.
Rate of Increase in Several Towns Compared.*
The following Table is interesting for the reason that although in several
towns, both in England and Scotland, the rate of increase in Grlasgow has been
exceeded, no population approaching it in size has approached it in the rate of
increase : —
Towns.
Enumerated Population.
Increase
per cent.
1891.
1901.
1891-1901
London,
4,228,317
4,536,063
7-28
Liverpool,
629,548
684,947
8-80
Manchester, ...
505,368
543,969
7-64
Birmingham,
478,113
522,182
9-22
Leeds, ..."
367,505
428,953
16-72
Sheffield,
324,243
380,717
17-42
Edinburgh, ...
276,066
316,793
14-75
Dundee,
154,118
161,166
4-57
Aberdeen,
124,943
153,497
22-85
Paisley,
66,425
79,364
19-48
Leith,
68,707
77,438
12-71
Greenock,
63,422
68,115
7-40
Go van.
63,625
76,351
.. ^ 20-00
Partick,
36,538
54,274
48-54
GLASGOW,
658,073
761,712
15-75
England and Wales,
12-17
Scotland,
11-09
Institutional Population and Shipping.
For the purpose of the Census and for certain sanitary purposes, the per-
sons residing in Institutions and on board ships in the Harbour and Canals are
enumerated and dealt with separately. At the enumeration of 1891 and 1901
these were : —
Increase
Census. . 1891. 1901. per cent.
Population in Institutions, ' 12,800 19,347 51-1
Shipping, 750 1,241 65-5
The areas of some of those towns were extended in the decennium of 1891-1901, but in every case
the population in 1891 relates to the town as constituted in 1901.
9
The following quotation from the Registrar- General's instructions to
Registrars will indicate tlie reasons which, govern the inclusion of any Institu-
tion within this class.
"13. At the end of the form [for plan of division] you will insert the
name of every public institution having more than 100 inmates, and the
Governor or head of which you recommend to the Registrar-General to be
appointed its enumerator. All smaller institutions will be dealt with as
ordinary houses in the enumeration district in which they are respectively
situated."
The Institutional population, as thus defined, shows an increase of 6,547.
The inmates of Model Lodging-houses alone would appear to show an increase
of 3,651, but the records in the present Census cover 26 Institutions of this
class, compared with 13 at the Census of 1891. Some of these now added existed
in 1891, but were then dealt with as houses. In addition, certain other
Institutions are now also included for the first time, and these, with the added
Model Lodging-houses, are marked with an asterisk in the subjoined Table.
The only valuable comparison therefore which can be made is between the
Model Lodging-houses of which there is a record at both periods, and in them
the inmates have increased from 4,160 to 4,737.
Census 1901. —Glasgow — Table showing the Number op Inmates in Institutions
OP Different Kinds.
Institution. Inmates.
Model Lodging-Houses —
Corporation —
Drygate,
Greendyke Street,
Clyde Street,
JSTorth Woodside Road,
Hydepark Street,
Portugal Street, . . .
Moncur Street (Females),
*Family Home, ...
Private — ■
*66 Moncur Street,
179 Great Hamilton Street,
*173 High Street,
*195 High Street,
*34 Stirling Street,
*48 Duke Street,...
39 Watson Street,
21 Watson Street,
14 Watson Street,
*6-14 Miller's Place,
28 M'Alpine Street,
*22 James Watt Street,
*1 Burns Street, ...
*16 Garscube Lane,
*(Clydesdale), Hydepark Street,
*(Carlton), Buchan Street,
(Kingston), Centre Street,
*Maryhill,
2,802
369
286
369
358
349
429
267
375
193
700
170
146
195
207
352
520
111
114
316
379
401
255
134
403
311
102
5,009
7,811
Carry fonvard,
7,811
Included as Institutions for the fir.st time in 1901.
10
Institution. Inmates.
Brought forward, ... ... 7,811
Hotels (4 in number), ... ... ... ... ... ... ... 615'
Royal Infirmary, .. . ... ... ... ... ... ... ... 738
Western Infirmary, 635
Victoria Infirmary, ... ... ... ... ... ... ... 218
Eye Infirmary, ... ... ... ... ... ... ... ... Ill
Royal Hospital for Sick Children, ... ... ... ... ... 114
Eastpark Home, 109
Royal Lunatic Asylum, Gartnavel, ... ... ... ... ... 556
*City Fever Hospital, Parliamentary Road, ... ... ... ... 298
Do. Belvidere, . . . ... ... ... ... ... 689
* Do. Ruchill, 766
*City Reception-House, South York Street, ... ... ... ... 102
; 4,336
Slatefield Industrial School, ... ... ... ... ... ... 177
St. Mary's do. (Boys), 210
Do. do. (Girls), 208
MaryhiU do. (Girls), 200
795
Central Police Office, 130
H.M. Prison, Duke Street, 419
549'
241
201
123
254
87
102
1,667
1,431
142
160
132
701
5,241
Total within Municipal Boundaries, ... ... 19,347
St. Joseph's Home, Garngadhill,
*Homes for Old Men and Old Women, Rottenrow,
*City Orphan Home, James Morrison Street, ...
Night Asylum for the Houseless,
*Mission Hall for Friendless Females, ...
Magdalene Institution, MaryhiU,
City Poorhouse, ...
Barnhill Poorhouse,
Deaf and Dumb Institution, Langside, ...
*Roman Catholic Training College, Dowanhill, . . .
*01d Barracks Show Ground, Gallowgate,
Government Military Barracks, MaryhiU,
Shipping.
The number of persons resident on board ships in the Harbour and Canals
increased from 750 in 1891 to 1,241 in 1901. Formerly the number of persons
thus returned maintained a fair degree of constancy, the figures for each
Census, 1861-1891, being 639, 569, 590, and 750 respectively.
As the quayage within the Municipality has not increased during the
decade, the increase in the Harbour population is most likely related to some
alteration in the manning of large steamships by Lascar and Chinese crew^s, who
live on board while the vessels are in port — the proportion resident on board those
in the Canals being so small that it may be discarded. Regarding this Mr. T. R.
Mackenzie writes : —
" I have made some inquiry into the matter you refer to, and think there can be no
doubt that the explanation you suggest is the true one for the abnormal increase in the
number of persons living on board ship, as shown by last Census.
" When the previous Census was taken the Anchor Line's eastern vessels, and the
Clan Line, had only partially introduced coloured crews, now their employment of
Lascars is greatly extended, while the City Line and Messrs. P. Henderson k Co.
have also manned their vessels in the same way."
* Included as Institutions for the first time in 1901.
11
The extent of quayage is given in 1891 as 10,920 lineal yards, but this does
not distinguish between the Docks of Glasgow, Govan, and Partick, and I am
indebted to Mr. Mackenzie for the following measurements as at 30th June, 1901:—
Clyde Navigation.
Length of Quays (including ferry stairs, &c.) as at 30th June, 1901 :—
City or Glasgow.
Lin. Yards. Lin. Yards.
501|
4,911
830
3,334
9,576|
BUBGH OF GoVAN.
Glasgow Lower Harbour, ... ... ... 1,373|^
Prince's Dock, ... ... ... ... 3,737
5,1101
Govan Passenger Wharf, ... ... ... ... 46f
Shieldhall Old and New Wharves, ... ... ... 381i
Total Lineal Yards, ... 15,115
Age and Sex Distribution.
At each enumeration since 1861 the proportion of males to females in the
population has increased, a circumstance which would appear to be related to
some alteration in industrial conditions resulting in a relative increase of the
opportunities for male employment. Since 1851 the proportion of males to every
100 females has been as follows : —
1851, ... 89'0 1881, ... 94'5
1861, ... 88-5 1891,* _ 94-6
1871, ... 94-0 1901, ... 96-2
1901.— Scotland, 94-5. England and Wales, 93-5.
Glasgow Upper Harbour, ...
,, Lower Harbour, ...
Kingston Dock, ^
Queen's Dock,
Numbers of each Sex living at various Age Periods. — Age and Sex
Distribution.
In the following Table the number of each sex living at certain age
periods is given for the whole City.
Table II. in the Appendix contains the number of each sex living in each of
the Sanitary Districts at corresponding age periods, and in Table V. these are
stated as a percentage of the total living at all ages.
* Greater Glasgow,
12
Glasgow — Census 1901. — Age and Sex Distribution.
Age.
JMales.
jj rjiViAi-iJliO.
Under 1 year, ...
10,423
10,243
20,666
1-5 years, ...
34,908
35,251
70,159
5-10 „
40,156
39,665
79,821
10-15 „
37,049
37,617
74,666
15-20 ,
37,670
39,136
76,806
20-25 „
40,955
42,364
83,319
25-35 „
DO, / DO
D / ,3 J 9
ioo,Uo t
35-45 „
46,605
47,729
94,334
45-55 „
32,356
33,029
65,385
55-65 „
18,351
21,638
39,989
65 ,, and upwards,
9,244
14,128
23,372
Not known,
50
58
108
All Ages, ...
373,535
388,177
761,712
1891, All Ages,
319,909
338,164
658,073
Compared with 1891 this shows a numerical increase of 53,526 males and
50,013 females, representing a rate of 16"7 per cent, for males and 14"5 for
females. In Scotland, as a whole, males increased by 11 "8 per cent, during the
decennium, and females by 10"37 per cent., while in England and Wales the
increase of females exceeded that of males, the rates being 12'4 and 11*9 per
cent, respectively.
Before we can compare the sources of increase in each sex, we must fall
back upon the assumption already referred to in dealing with the population as
a whole, and supply for the period from 1st April to 31st December, 1891, a
number which will represent the rate which obtained in remainder of the decade.
Glasgow. — -Natural Increase by Excess of Births over Deaths during
THE Period from 1st January, 1892, to 31st March, 1901.*
The births and deaths registered during the 37 quarters of the decennium
ending 31st March, 1901, were as follows : —
Births.
Deaths.
Excess of Births.
Males,
111,270
73,222
38,048
Females,
106,999
69,752
37,247
Both Sexes,
218,269
142,974
75,295
* The Births are taken throughout from the Registrar-General's Mouthly Reports.
The Deaths are from the Registrar-General's detailed Reports from 1S92 to 1899, and from the
Monthly Reports for 1900 and the first quarter of 1901.
13
t We can now, after adding the estimated births and deaths in the last three
quarters of 1891, use these figures to build up a Table which will show the balance
of increase resulting from the excess of immigration over emigration.
Males.
Females.
Census, 1891,
319,909
338,164
Births minus Deaths, April, 1891, to April, 1901,
41,137
40,268
Population, 1901, by natural increment,
361,046
378,432
., ,, as enumerated,
373,535
388,177
Difference — being gain by excess of arrivals over
departures.
12,489
9,745
The natural increment of males constitutes 76-7 per cent, of the total
increase, that of females, 80-5 per cent., so that the proportion of males added by
immigration is greater than females. There is a balance of influx equal to 2,223
persons annually, of whom 1,249 are males and 974 are females.
Proportion of Males and Females living at several Age Periods in
EVERT 100,000 OF EACH SeX IN 1891 AND 1901 COMPARED.
1901.
1891.
Age.
Males.
Females.
Males.
Females.
12,136
11,722
0- 5 years.
13,051
12,332
10,752
10,220
5-10 .,
11,531
10,788
9,920
9,692
10-15 „
10,635
10,192
10,086
10,083
15-20 „
10,249
10,247
10,966
10,915
20-25 „
10,378
10,098
17,609
17,345
25-35 „
16,666
16,640
12,479
12,298
35-45 „
12,166
11,642
8,663
8,510
45-55 ,,
8,348
8,855
4,914
5,575
55-65 „
4,548
5,479
2,475
3,640
65 and upwards,
2,428
3,727
100,000
100,000
All Ages,
100,000
100,000
This Table enables us to compare the age constitution of the population
in 1891 and 1901, and the comparison is not without significance. At all
ages under 20 there are now relatively fewer persons of each sex living than in
1891, and the converse holds true for each age period above this, save for females
at ages 45-55, and again over 65. The factors contributing to this are a falling
birthrate and an influx of immigrants, who are usually young adults. We are
thus, as a population, becoming older in the literal sense to which the phrase
is applicable to the individual, and an extension of the comparison will help
to gauge the extent of this.
14
Without any serious error this comparison may be carried back to 1881^
hearing in mind the extension of the area in 1891. The Umited influence of this,
however, on the age distribution, is indicated by the proportions living at ages
0-25 and 25-65 in 1891, forming almost a middle term to those in 1881 and 1901.
Proportion per cent, of the Population Living at various Age Periods
IN Three Successive Census Enumerations.
Age.
1881.
1891.
1901.
0-5
13-70^
12-68^
11-92^
5-10
10-15
15-20
1M2
9-76
10-28
. ^
>o
11-15
10-41
10-25
-*
10-48
9-81
10-08
cr>
■
cc
20-25
10-56 J
10-23.
1094.
25-35
16-39'
16-65^
17-47'
35-45
45-55
11-95
8-30
o
11-90
8-61
Oi
-
12-39
8-59
o
eo
55-65
5-06,
5-03.
5-25.
65 and upwards,
2-88
3-09
3-07
Taking the ages 25-65 as representing the period of maturity, the proportion
of the population living therein has increased in 20 years from 41-7 to 43-7 per
cent., while the proportion of the population at ages 0-25 has fallen from 55-4
to 53-2 per cent. Although the adult ages contain the most actively productive
period of life, there are fewer recruits coming forward to fill their places.
Irish Born.
Per Cent, of
Total Population.
1851, 60,058 18
1861, 63,574 15-8
1871, 70,410 14-4
1881, 65,185 13
1891, 57,618 10-2
1901* 66,106 8-7
HOUSING.
The inhabited houses numbered 155,404, compared with 134,882 at last
Census, an increase of 20,522, or 15-2 per cent. In addition, 7,274 were found
empty, compared with 6,663 at the Census of 1891. The inhabited houses con-
tained 401,543 windowed rooms, and were occupied by 741,124 persons, the
balance of the population being distributed among Institutions and Shipping,
as formerly described.
Were the houses of equal size, each would contain 2-584 rooms, and were
the population equally distributed among them, each house would contain 4-769
* Greater Glasgow.
15
persons, and each room 1-846. This affords a convenient way of expressing
the size of an average house and the average number of persons inhabiting it,
but it lacks the advantage of conveying information regarding the average size
of the rooms. Obviously, also, it is only relatively applicable to existing con-
ditions, and later, when considering the occupancy of one and two apartment
houses, we shall see how widely it is departed from. But it enables a com-
parison to be established between the average size and the average occupancy
of houses in this and former decades, and between the average conditions in
this respect existing in Glasgow and other towns. It affords evidence that the
average house is undergoing a gradual enlargement in size, and the ocGU])ants
per room a gradual reduction in number.
To obtain, however, any clear estimate of the changes which have taken
place during the decade in the character of the housing accommodation, it will
be necessary to keep in view the area of the City before and after the extension of
1891. This is owing to the character of the average house in the added districts.
It had a greater average number of inmates, but fewer in relation to the number of
occupied rooms. In Old Glasgow, at the 1891 Census, the average house had 2-325
rooms and contained 4-727 persons, or 2-033 per room ; in the added area it had
4'167 rooms, and was occupied by 5-128 persons, but it had only 1-230 inmates per
room ; in both together it contained 2-562 rooms and 4-778 persons, but the average
number of persons per room was reduced to I'SGS. With this explanation we can now
compare corresponding details for three Censuses : —
Rooms per House.
Persons per House.
Persons per Room.
1881,
2-322
4-738
2-040
1891 (Old Glasgow),
2-325
4-727
2-033
Added Districts,...
4-167
5-128
1-230
Whole Area,
2-562
4-778
1-865
1901,
2-584
4-769
1-846
The removal of the decimal point will facilitate the reading of these
figures, so that they may be taken as whole numbers applicable to 1,000 houses
of average size. These now contain 22 rooms more than a similar number of
houses in 1891, which may also be expressed in this form : that 1,000 houses of
the present average size are the equivalent of 1,008 6 houses in 1891.
The indication which this affords of a gradual upward tendency in the
standard of house accommodation accords with experience elsewhere in Scot-
land. In the following Table, Edinburgh and Dundee alone show a continuous
reduction in the size of the average house during three decades, but in all
the towns quoted for which the information is available for more than one
Census, there is a reduction in the average number of inhabitants per room,
which is the most important sanitary factor in the question of housing.
In Edinburgh, Aberdeen, and Perth the size of the average house
exceeds the average for Scotland, and they have also fewer persons per room.
In Dundee, Paisley, and Govan it is smaller than in Glasgow ; in Paisley and
Govan the number of persons per room is greater.
16
Census, 1901. — Table showing the Average Number of Rooms per
Inhabited House, and of Persons per Room (including Institutions),
IN certain Towns and Burghs of Scotland, at the Censuses of
1881, 1891, AND 1901.*
Rooms per Inhabited House.
Persons per Room.
188L
189L
1901.
1881.
1891.
1901.
Glasgow, ...
2-34
2-34
2-054
2-054
Greater Glasgow, ...
2-59
2-62
1-884
1-868
Edinburgh,
4-19
4'16
3-93
1-320
1-231
1-221
Dundee,
2-85
2-62
2-50
1-870
1-842
1-752
Aberdeen, ...
3-42
3-22
3 '27
1-511
1-437
1-405
Greenock, ...
2-64
2-71
2-74
1-907
1-823
1-796
Leith,
2-98
3-06
3'07
1-671
1-608
1-567
Paisley,
2-42
2-47
2-50
1-984
1-969
1-948
Perth,
4-96
3-86
3-87
1-312
1-233
1-174
Kilmarnock,
2-59
2-63
1-876
1-829
Go van.
2-26
2-191
Partick,
2-95
1-630
Scotland, ....
3-21
3-20
3-26
1-60
1-55
1-48
Grouping of the Population in Houses op various Sizes.
The following Tables illustrate the widely- varying conditions under which the
population is housed. Attention will chiefly be directed to the proportion of
houses of one and two apartments, which together form 67 per cent, of the
total houses, and accommodate 61 per cent, of the population : —
Glasgow. — Census 1901.
Inhabited
Population.
Persons.
Houses.
Per House.
Per Room.
1 Apartment, ...
32,709
104,128
3-183
3-183
2 Apartments, ...
70,784
348,731
4-927
2-463
3 Apartments, ...
28,055
151,754
5-409
1-803
4 Apartments, ...
10,933
58,272
5-330
1-332
5 Apartments and upwards.
12,923
78,239
6-054
1-270
155,404
741,124
4-769
1-846
* As the population of Institutions cannot be excluded in the case of the other towns, it has been
necessary to deal with the whole population of Glasgow in this calculation, which accounts for the
slight difference between the figures given here and elsewhere.
17
Peoportion per cent, of Houses of Certain Sizes, and Proportion per
CENT. OF Population inhabiting them in 1891 and 1901 compared.
These proportions can be accurately stated for the area as existing at the
Census of 1891 and at that of 1 901, but they are only comparable within the limits
afterwards described.
Sizes of Houses.
Percentage of Houses of Different
Sizes.
Percentage of Population occupy-
ing each Class.
1891.
1901.
1901.
1891.
1901.
1901.
1 apartment,
(1)
26 40
(2)
23-80
(3)
21-05
(4)
18-051
(5)
15-89
(6)
14-050
2 apartments,
45-34
47-93
45-55
47-482
49-95
47-054
3
16-85
17-52
18-05
19-668
20-49
20-476
6-05
5-77
7-03
7-204
6-86
7-863
5 ,, and upwards,
5-36
4-98
8-32
7-595
6-81
10-557
Columns 1, 2, 4, and 5 of the above Table apply to the area of the City at
the Census of 1891, while columns 3 and 6 apply to the present area. The
data for the corresponding calculation for the whole of the added districts at
1891 do not exist, but columns 2 and 5 have been calculated to show the changes
which had taken place in 1901 within the area of the 1891 Census. They are^
therefore, comparable with columns 1 and 4.
One-Apartment Houses. — In 1891, 26-4 per cent, of the houses were of one
apartment, and 18 per cent, of the population lived in them. In 1901 these
proportions were 21 and 14 per cent, respectively, but when the comparison is
confined to the area of Old Glasgow, the reduction is only to 23-8 per cent, for
houses and to 15:9 per cent, for population.
Two-Apartment Houses. — The proportion of houses of this class is little
altered when the old and new areas are compared, while the proportion of popula-
tion inhabiting them is Only slightly lowered in the latter. Now, as formerly,
therefore, almost one-half the population live in houses of two apartments. But
within the older area the proportion of such houses has inci-eased by 2-59 per cent.,
and the proportion of population in them by 2-47 per cent.
Taking houses of one and two apartments together, they now form 66'6 per
cent, of the total inhabited houses, compared with 71-7 per cent, in 1891,
and are now inhabited by 61 per cent, of the population, instead of 65-5 in 1891 ;
but, confining the comparison to the limits of the old area, the proportion in both
cases is practically maintained, being 71-74 against 71-73 for houses, and 65-53
against 65-84 for population.
Reduction in One-apartment Houses.
This constancy in the proportion of houses of both sizes within this area has,
as we have seen, been accompanied by a change in the relative proportion of each,
so that the actual change which has taken place must be further examined on the
basis of the numbers existing at each Census.
There were 31,032 houses of one apartment at the Census of 1891. At the
present Census they numbered 32,709, but 2,273 of these are in the added
\
18
districts — 1,779 being in' the districts of Maryhill (30) and Possilpark and Barn-
liill (31) alone — leaving 30,436 for the old area. The reduction ^n the propor-
tion of one-apartment houses in Old Glasgow, therefore, has been accompanied by
an actual reduction of their number by 596.
Old Glasgow. — One-Apartment Houses, 1891 and 1901, Compared.
Houses.
Population.
Proportion of
Houses of all
Sizes.
Proportion of
Population
Occupying.
Persona per
Eoom.
189L
31,032
100,298
26-40
18-05
3-232
1901,
30,436
96,586
23-80
15-89
3.173
Decrease, ...
596
3,712
2-60
2-16
-059
Added Districts, 1901,
2,273
7,542
9-0
5-7
3-318
Coincident with this reduction in the number of houses of this size within
the older area, the population inhabiting them has been reduced by 3,712 and
the average number of persons per room from 3-282 to 3'173. This latter figure
is to be compared with 3'183, which is the average occupancy of all one-apartment
houses, and brings into contrast the relatively greater average number of occupants
of one-apartment houses in the suburbs, which is 3-318 per house.
This had been observed in 1891 as applicable to houses of one and two
apartments in the landward portions of the Glasgow Registration Districts*
(Dennistoun, St. Rollox, Hutchesontown, Gorbals, Tradeston, and Kinning Park),
which were then already otherwise partly urban, while in three and four apartment
houses the reverse was the case, and the figures are repeated in the following
Table for convenient reference : —
Average Number of Inmates per Room in Old Glasgow and Added
Districts, and in Greater Glasgow.
1 Apartment.
2 Apartments.
3 Apartments.
4 Apartments.
1891, Old Glasgow,
3-23
2-47
1-84
1-41
Landward Portions of
Registration Districts,
3-58
2-60
1-74
1-19
1901, Glasgow,
3-18
2-46
1-80
1-33
Old Glasgow,
3-17
2-48
1-85
141
Added Districts,
3-32
2-38
1-61
1-17
We shall have an opportunity further on of considering the actual change
which has taken place during the decade in the number of one-apartment houses
in the several Sanitary Districts within Old Glasgow ; but, as representing in a
minor degree the change in social conditions which an increase in houses of this
size indicates, the following Table shows those districts in which the proportion of
houses of this size is now greater than in 1891 : —
* Along with these are included the figures for the Burghs of Hillhead and Maryhill and the
District of Kelvinside.
19
DiSTKicTS OF Old Glasgow in which the Proportion of One-Apartment
Houses has Increased.
No. of 1 apartment Houses.
Inhabitants.
1891.
1901.
1891.
1001.
•">
Port-Dundas,
254
332
813
1,019
9.
Monteith Row, ...
174
172
524
542
i;5.
Brownfield,
128
135
356
409
17.
Kelvinhaugh and Sandy-
ford,
359
392
1,063
1,119
Monteith Row has been included here, although there is a reduction of
two in the number of such houses. The total number of houses of all sizes in
this district has, however, decreased, but to a greater extent, so that the proportion
of houses of one apartment is now greater than it was ten years ago.
Sub-divided Houses.
There is some reason for thinking that were the condition of individual
occupancies accurately known, some portion at least of the houses which we have
just been considering as of two or more apartments would be transferred to the list
of one-apartment houses, and each room regarded as separately occupied. This
consideration does not alfect the comparison with former years, but it should be
borne in mind.
A house, as defined for Census purposes, has certain limitations. It must
have —
(1) A distinct outside entrance from a street, court, lane, road, &c., or
(2) A door opening directly into a common stair or passage ; hut any such
dwelling if subdivided and occupied by different families is to be reckoned as
one house.
From this definition, it is obvious that the primary conception of a house
for Census purposes may, in respect of the latter qualification, fail to convey
its significance as a sanitary factor, and, indeed, in the final Reports of former
Censuses the Registrar-General has been in the habit of regarding the number
of families as the index of the number of houses. For the present we must
deal with thera as now defined.
We have already seen that the total number of inhabited houses is 155,404.
In his preliminary Report on the present Census the Registrar-General gives
the number of " families " as 163,422, so that the '■ fomilies " exceed the houses by
8,018. What does this disparity cover ? As here used, however, the term " family "
has a restricted and purely conventional meaning, which we need only for the
present consider in so far as it relates to the separate occupancy of rooms in the
subdivided houses referred to in the definition just quoted.
A common illustration is afforded by a two-apartment house, where each
apartment is entered separately from a common lobby and occupied by a separate
family. Some semblance of privacy is still possible to the several occupants,
although the water supply for both is at the kitchen sink ; but where the room or
second apartment is only reached through the kitchen, independent family life
20
becomes impossible. The house and its appurtenances, originally designed for the
requirements of one family, are now shared by two, and each apartment becomes a
one-roomed house under the worst possible conditions. We know that this noo
infrequently occurs in several houses in one tenement under fluctuating conditions
of occupancy. The farmed-out house is largely of this class. In January
of this year (1902), 859 such were on the register; 531 of these were classed
as single-apartment houses, the remaining 328 were houses varying in size
from 2 to 9* apartments. These latter contained 741 rooms, which, added to the
531 properly regarded as single apartments, gives a total of 1,272 rooms used
mostly as single apartments, and not necessarily restricted in their occupancy even
to separate families until Section 17 of the Provisional Order of 1901 came into
operation this year.
The following Table shows the number of farmed-out houses in each sanitary
district, with the number of each of various sizes, as known in January, 1892 : —
Farmed-out Houses.
Sanitary
Sub-
T)l VI <51 r>Tl Q
-L/1 V ioHJllb.
1
Apt.
2
Apts.
3
Apts.
4
Apts.
5
Apts.
6
Apts.
7
Apts.
9
Apts.
Total.
Apart-
ments.
Percentage
of Farmed-
out Houses
Houses.
1.
8
3
11
28
•3
3.
27
6
2
1
1
37
56
2-0
4.
32
32
32
1-0
5.
62
19
5
2
88
123
0-5
6.
26
26
2
54
84
4'9
8.
10
4
14
18
0-2
9.
13
13
5
2
1
1
35
82
4-2
10.
6
7
1
1
15
28
2-0
11.
143
50
9
2
204
278
4-4
12.
4
4
8
12
1-8
13.
37
33
4
74
115
10-8
14.
37
30
2
2
71
111
9-2
16.
46
5
51
56
1-3
18.
58
31
3
92
129
1-6
19.
1
1
2
3
0 0
20.
4
4
4
0-2
21.
1
14
2
17
35
0-1
22.
24
24
2
50
78
2-0
Total,
531
275
37
9
2
3
1
1
859
1.272
* The inclusion of houses having more than two rooms among farmed-out houses is a sanitary
necessity, but it has not at present legal sanction {vide Public Health Act, Section 72 (2) ).
21
The growth of the farmed-out house needs the laiost constant watchfulness
and it is a matter for consideration whether an annual census of its occupants
would not well repay the trouble and cost involved.
Its existence had no legal recognition until the passing of the Public
Health (Scotland) Act, 1897, but its evolution from the class of " Houses Let in
Lodgings " began prior to this. Its occupant falls short of the standard by
which the caretaker or house-factor estimates the desirable tenant. Yet his
rent-paying power is considerable. £13 annually represents the sum of the
weekly payments for a single room so occupied, only £2 less than the average
rent of a three-apartment house. The attraction to the occupant is that he
need produce ho evidence of former regularity in rent-paying ; that it now may be
paid in nightly doles of lOd., or 5s. per week, for which also he has the use
of certain domestic furnishings in their simplest form. The solatium to the
house-farmer for occasional loss from unlet rooms or destruction of furnishings
is the return of 20s. per four weeks from premises which he leases at something
between 6s. and 8s. a month.
There is another point of view, however, from which these houses may be con-
sidered. The present legal standard of air-space per adult in these and other smaller-
sized houses in private occupancy is 400 cubic feet, and this is applicable also to
the dormitories of Common Lodging-houses, which are under regulation as to
ventilation and cleanliness. But the 400 cubic feet of a Common Lodging-
house is reserved exclusively for sleeping purposes, while the corresponding
space in the private house is in constant occupancy, and is used both for living
and sleeping purposes. The value, therefore, to the inhabitant of each, of the
legal allowance of air-space at his disposal must be appraised by a different
standard, if indeed, they are to be regarded as at all comparable, which, in fact,
they are not. The balance is against the occupant of the smaller dwelling, the
air of which, under conditions of almost continuous occupancy, can rarely be
rendered pure.
Question of Overcrowding.
We have already seen that 14 per cent, of the population are living in houses
of one apartment, with an average occupancy of more than three persons per room,
and that 47 per cent, of the population are living in houses of two apartments, with
an average occupancy per room of almost 2'5 persons. Both figures are in excess
of the average room-density, and, as this affects 61 per cent, of the population,
some effort is requisite to discover what it implies.
In considering the question of overcrowding in England and Wales at
the Census of 1891, the Registrar- General adopted the standard of two persons
per room as representing the limit of reasonable occupancy, and regarded any
excess over this in houses of less than five rooms as indicating, save in exceptional
circumstances, the degree of overci'owding which existed. On this basis most of
the recent enquiries into overcrowding in English cities has proceeded, and a
comparison * has lately been established in which the figure which represents
the proportion of the Glasgow population living more than two in a room is used
to indicate a comparable condition.
* "Poverty: A Study of Town Life, " p. 171. By B. Seebohm Rowntree. London : Macmillan
& Co., Ltd., 1901.
The method here adopted proceeds by excluding the proportion of one, two,
three, and four-apartment houses, in which the persons resident do not exceed twice
the number of apartments in each size of house, and calculating the number living
in excess of this as a percentage of the total population. .Corresponding detail
is not yet available for the present Census, but the figures referable to that of
1891 are sufficiently illustrative. The figures of the following table are from
Mr. Eowntree's work, and reference may also be made to Volume VI. of the
Census Report for England, Table 30, Appendix A, and to the Tenth Decennial
Report for Scotland, Volume I., page 331.
Towns.
1891.
Newcastle-on-Tyne,
London, ...
Leeds,
Proportion per cent,
of Persons living more
than 2 per Room to
Total Population.
35
19
16
Towns.
1891.
Sheffield,
Liverjjool,
Manchester,
Proportion per cent,
of Per.sons living more
than 2 per Room to
Total Population.
11
10
Glasgow,
59
The social significance of this contrast has its value, but the disparity
presented by the proportion of persons so living in the several cities suggests a
fundamental difference in the average size of room which we may endeavour to
elucidate.
Dr. Sykes, in the Milroy Lectures for 1901, states that in England the cubic
space per room may be stated as varying from 600 to 1,400 cubic feet, but
mainly from 800 to 1,200, and takes the average of 1,000 cubic feet as fairly
representing the air-space per room in houses of less than five apartments in
large towns.
Before, however, this can be compared with corresponding measurements in
Glasgow some further consideration is necessary. It is customary in Glasgow to
exclude the bed space and lobby, if that is separated by a door, in calculating the
cubic capacity of a room. In London, on the other hand, where, as Dr. Sykes
informs me,* the ordinary house has a front and a back room on each floor, there is
no lobby and no bed recess, while any recess within a room would be reckoned as
part of the cubic space therein.
Keeping these differences in view, a comparison of the internal air-space in
houses in both cities may be approached.
Cubic Space per House in Glasgow.
By the Glasgow Police Act, 1866, the minimum air-space per apartment in
new houses was fixed at 900 cubic feet, and was raised to 1,000 cubic feet by the
Building Regulations Act, 1892. The following measurements taken in 1886
represent the average in three districts.f
* Dr. Sykes since writes me : — " 'J'he Housiug of the Working Classes Committee of the London
County Council made building regulations approved by the Council on 3rd December, 1889, and these
regulate the size of rooms in new buildings for the working classes in London. With a minimum of
8J feet (ceiling), the minimum floor area for bedrooms is 96 square feet, and for living rooms
144 square feet. This means respectively 816 and 1,244 cubic feet, and the mean of the two is 1,020.
The average always seems to come near 1,000."
+ See " Vital Statistics," Part II., pp. 70, 71. (Dr. Russell.)
23
(1) Cubic Contents of Houses in Tradeston.
SrzE OF House.
No. of
Houses.
Mean Cubic
Space
per House.
Mean Cubic
Space
per Room.
1 Apartment,
100
1,007
1,007
2 Apartments,
104
2,077
1,038
3 Apartments,
110
3,656
1,219
There are 314 liouses in this group, all in Tradeston, which was feued by
the Trades' House at the end of last century.
(2) Cubic Contents of Houses in District 15, or Woodside.
Size of House,
No. of
Houses.
Mean Cubic
Space
per House.
Mean Cubic
Space
per Room.
1 Apartment,
100
1,268
1,268
2 Apartments,
100
2,498
1,249
3 Apartments,
23
3,722
1,240
These 223 houses are nearly all in tenements then recently built in Hopehill
Eoad, and fairly represent the ordinary run of artizans' dwellings erected by
private enterprise under the usual conditions of the Glasgow Police Act, 1866.
(3) Cubic Contents of Houses — Oatlands and Overnewton.
Size of House.
No. of
Houses.
Mean Cubic
Space
per House.
Mean Cubic
Space
per Room.
1 Apartment,
116
1,344
1,344
2 Apartments,
137
2,637
1,318
3 Apartments,
101
3,999
1,333
These 354 houses are all situated on the lands of Oatlands and Over-
newton, which were purchased by the Improvement Trust, and feued m ac-
cordance with a plan carefully laid out by the Master of Works, reserving in
each case a central square as breathing space. They represent the best class of
modern artizans' dwellings in the City.
24
This is the record of measurements taken in 1886, and may be compared with
the following figures, which show the average cubic space in houses whose erection
was sanctioned during the past decade, and for which I am indebted to the Master
of Works.
Size of House.
No. erected
Sept. 1891, Aug. 1901.
Cubic Contents,
Including Lobby
and Bed Space.
Cubic Contents,
Excluding Lobby
and Bed Space.
1 apartment, ...
5,665
1,700
1,300*
2 apartments,
17,355
(a) Room,
1,400
(b) Kitchen,
1,200
Together, ...
3,400
2,600
This gives the average free air-space per room in houses of recent construc-
tion at 1,300 cubic feet, and, if we add the 240 cubic feet of bed-space, to meet the
inclusion of recesses within a room which are reckoned in London as forming part
of the entire cubic space thereof, we have in our most recently erected one and
two-apartment houses air-space which exceeds by one-half the average contents of
the room in London, and indieates three persons per room as the equivalent of
the English standard of two. In ten* of our districts only is the average occupancy
of one-apartment houses lower than this.
Intercensal Changes of Population and in House Accommodation in the
Various Sanitary Districts during 1891-1901.
In order to epitomise this, the following Table has been prepared :— It shows
that in twelve Districts of Old Glasgow the population has decreased during the
decade at rates varying from 1'5 per cent, in Blythswood to 33 per cent, in Bridge-
gate and Wynds. Between these extremes lie High Street and Closes East and
West, Monteith Row, St. Andrew Square, Calton, and St. Enoch Square in the
Central and East Central Districts ; Anderston in the West ; Kingston, Laurieston,
and Gorbals in the South. In all, save High Street and Closes West, the houses
have likewise been reduced in number.
In the other Districts of Old Glasgow the increase in population has
ranged from 1 per cent, in St. RoUox to 25 Q per cent, in Springburn and Rock-
villa, and in these also the houses have increased in number, save in Brownfield,
where the population has increased by 3 per cent., while the houses have been
reduced by 1'9 per cent.
In all the added Districts the rates of increase have reached a high level,
save in Hillhead where the population has increased by 10'3 per cent, and the
houses by 9 '9 per cent.
In Maryhill the population has been doubled during the decade, and its
houses have been added to by 118-6 per cent.
* See Table VII., Appendix.
25
Movements of the Population in relation to Housing during the
Decennium 1891-1901.
Sanitary Districts.
Population, exchisive of
Institutions and
Sliipping.
Inhabited Houses.
Empty Houses.
Percentage
Increase.
Percentage
Decrease.
Percentage
Increa.se.
Percentage
Decrccise.
1S91.
1901.
— Ely thswood, ... ...
1-5
3-2
4-7
2-8
1. Exchange, ...
1 1 -0
X X -1
11-4
■J U
2. Port-Dundas,
144
16-7
4-6
1 7-0
.3. Hi^h Street and Closes West,
4-3
1-2
4-6
o u
4. St. RoUox, ...
ro
1-7
2-6
3-1
k) X
5. Bellgrove and Dennistoun, ...
25-3
25-5
3-8
t: O
6. High Street and Closes East,
10-G
S-3
7-9
rt _j
7. Greenhead and London Road,
2t-7
23-7
3-1
8. Barrowfield, ...
2-8
0-6
O -J
9. Monteith Row,
8-1
10-0
O X
10. St. An(h-ew Square,
2-8
7-7
5-0
*x i
11. Calton,
5-1
7 '0
12. St. Enoch Square,
30-7
31-0
X X -J
o o
13. Brownfield, ...
3 3
1-9
31
o o
14. Bridgegate and Wynds,
33-8
30-4
12-5
2-4
15. "VVoodside,
19-8
19-6
4-4
3-7
16. Cowcaddens,
8-1
5-2
7-1
17. Kelvinhaugh and Sandyiord,
3-8
3-9
3-S
3-6
18. Anderston, ...
2-8
3-8
2-7
2-6
19. King.ston,
1-9
3-3
4-4
2-7
20. Laurieston, ...
2-1
5-1
3-9
3-6
21. Hutcheson Square, ...
10-4
9-4
3-3
3-2
22. Gorbals,
7-1
10-2
3-7
3-7
— Springburn and Rockvilla, ...
25-6
29-5
3-7
3-S
23. Govanhil],
36-3
43-2
3-6
3-4
24. Crossbill,
76-5
87-7
6'0
5-7
25. Langside and Mount Florida,
58-5
73-6
10-7
7-8
26. Pollokshields, E., and Strathbungo,
30-0
41-3
7-0
6-2
27. Pollokshields, W., and Bellahouston,
61-4
69-2
5-4
5 '7
28. Hillhead,
10-3
9-9
9 0
5-1
29. Kelvinside, ...
28 0
34-2
8-3
8-0
30. Maryhill,
100-4
118-6
6-S
8-4
31. Possilpark and Barnhill,
35-9
36-7
• 5-5
5-2
— Institutions,
5M
— Shipping,
65-5
City,*
15-75
15-21
4-7
4-5
Including Institutions and Shipping.
26
In a general way, iiouses and population have increased or decreased
together, and the movement in both presents a fair degree of relationship. But in
High Street and Closes West and in Brownfield the population and houses have
moved in opposite directions.
The percentage increase and decrease in population and in houses in these
districts will be found in the foregoing Table. The actual change in the
houses is as follows : —
High Street and Closes West —
1891, ...
1 Apt.
708
•2 Apts.
.. 772
3 Apts.
.. 257
4 Apts.
... 94
5 Apts. and upwards.
36
All Sizes.
1,867
1901, ...
595
.. 894
.. 299
... 73
28
1,889
Difference, -
-113
+ 122
+ 42
- 21
-8
+ 22
Brownfield
1891, ...
128 .
422
.. 88
.. 50 .
8
696
1901, ...
135 .
.. 426 .
.. 71
.. 40 .
11
683
Difference,
+ 7
+ 4
-17
-10
+ 3
-13
In High Street and Closes West there has been much demolition and
rebuilding. It contains one of the areas of the Improvement Trust Act, 1897.
Brownfield is completely built over, and lO'S per cent, of the total houses are
farmed out.
In a former section we have seen that the one-roomed houses within the
area of Old Glasgow were reduced by 596 and their population by 3,712.
Can this displaced population be traced ? It has, as we have also seen,
failed to affect the average occupancy of the remaining one-roomed houses in
Old Glasgow, which has been reduced from 3"232 to 3'173. But in carrying the
enquiry into the several districts, we find seven in which the average occupancy
has increased. These are stated in the following Table : —
One-Apartment Houses. — Aveeage Number of Inmates per House in
Districts where the Proportion in 1901 exceeds that of 1891. (See
also Table VII., Appendix.)
Average Number of Persons
per Room.
Difference per
1,000 Houses.
IS9I.
1901.
St. Andrew Square, ,..
3-352
3-601
249
High Street and Closes East, ...
3-240
3-440
200
Cow;caddens, ... ... ... ...
3-164
3-255
91
Laurieston,
3-050
3-162
112
Monteith Row, ...
3-011
3-151
140
Brownfield, ... ...
2-781
3-030
249
St. Enoch Square,
2-962
2-973
11
Old Glasgow,
3-232
3-173
-59
27
It will be observed that the order of room density is maincained in both
periods, save in Brownfield; and if we here again discard the decimal, and
regard the change as expressing the actual increase in the nvimber of inmates
per 1,000 houses of this size, we find Brownfield and St. Andrew Square to have
their occupants increased by 249, High Street and Closes East by 200, Mon-
teith Row by 140,* and Laurieston by 112. This is one result in detail of the
displacement, while the balance will be fairly expressed in the increased
occupancy of two-apartment houses. Within the old area this has changed
only from 4'950 to 4'952 persons per house, a difference which may be neglected.
But, again, when we carry the comparison into the several districts and tabulate
those only in which it has increased, a striking cleavage occurs between those districts
Avhich have also had an increase in their one-roomed occupancy and those in which
this has not occurred. The column of differences in the following Table has
been arranged to show this: —
Two- Apartment Houses. — Average Number of Inmates per House in
Districts where it has increased in 1901.
Districts.
Average Number of
Persons per House.
Difference per 1,000
Houses.
1S91.
1901.
A.
B.
High Street and Closes West (3), . . .
4-763
4-775
12
Do. do.
East (6), ...
4-837
4-899
62
Greenhead and London
Road (7),
5-237
5-267
30
Barrowfield
(8), ...
5-073
5-156
83
Monteith Row
(9), ...
4-814
5-166
352
St. Andrew Square
. (lOj, ...
4-582
4-806
224
Calton ...
. (11), ...
4-927
4-949
22
St. Enoch Square
• (12), ...
4-616
4-758
142
Brownfield
. (13), ...
4-912
5-115
203
Kelvinhaugh and Sandyford (17),
4-498
4-560
62
A nderston
. (IS), ...
5-052
5-063
11
Laui'ieston
• (20), ...
4-960
5-121
161
Hutcheson Square
• (22), ...
4-926
4-988
62
Old Glasgow,
4-950
4-952
The first point to be noted in this Table is that it contains all save one of
the districts in which we have already seen the one-roomed occupancy to have
increased. The exception is Cowcaddens, in which the two-roomed occupancy
* Tlie portion of this district chiefly affected is that -which lies bet-sveen Gallowgate, Kent Street,
London Street, and Charlotte Street.
28
has been fractionally reduced, viz., from 5128 to 5-121 per house. But it also
shows that the increase which has taken place in the two-roomed occupancy is, with
one exception, relatively greater in those districts where there is also an increase in
the one-roomed occupancy. A comparison of the columns of difference shows the
extent of this, columns A and B distinguishing between the districts which have
and those which have not a coincident increase in the rate of occupancy of one-
apartment houses.
In a manner these Tables focus results only, but they present in a fairly
concrete form the districts in which increasing pressure on one and two apart-
ment houses has occurred. To proceed beyond this requires some local know-
ledge of the boundaries of the Sanitary Districts. But, in a general way, High
Street and Closes East and West, Bridgegate and Wynds, Calton, Monteith
Row, St. Andrew Square, and St. Enoch Sqiiare fairly lie within the the centre
of the area of Old Glasgow, and in these the one-apartment houses have been
reduced in number during the ten years by 975. Against this, there has been
an increase in Exchange District of 70, and in Port-Dundas, which, however,
is further removed, of 78. Bellgrove and Dennistoun District has 163 added
hou.ses of one ajDartment ; Greenhead and London E,oad, 291 ; but, save m the
extreme western limit of the former, it is doubtful whether any of the displaced
inhabitants of the Central Districts seek accommodation so far removed from
their original houses.
In the Western District, Anderston has 204 fewer houses of this size, and it
is difficult to dissociate from this the increased pressure in Brownfield with its
rapid development of the farmed-out house, although Kelvinhaugh and Sandy-
ford has added to its number by 33.
Similarly, on the South-Side, Kingston, Laurieston, and Gorbals have fewer
one-apartment houses by 449, against which there is alone an increase of 191 in
Hutcheson Square. In the Northern District of the old City, Springburn
and Rockvilla and Woodside have added 461, but the relatively low rate of
increase in the occupancy of one-roomed houses in Cowcaddens suggests
that more is wanted than the mere provision of house-room to attract
the inhabitant of one district to another which is probably more remote
in its associations than in actual distance from that to which he has been
accustomed. Eent and employment are powerful factors in determining
residence, but local associations must be reckoned with; and the Tables point
to the formation of limited areas of increased pressure on house accommoda-
tion round every centre of considerable displacement. Broadly speaking, three
such exist, in the Central, West, and Southern Districts of the City.
29
V'
Number of One-Apaetment Houses in the Sanitary Districts of
Old Glasgow in 1891 and 1901.
Sanitary Districts.
1891.
1901.
Increase.
Decrease.
Til
jDlytnswooa, ...
413
313
100
1
Exchange,
670
740
7(1
—
Z
Port-Dundas,
254
332
78
—
6
High Street and Closes W.,
708
595
—
113
4
bt. Kollox, ...
823
781
—
42
0
Bellgrove and Dennistoun,
3,196
3,359
163
—
/»
D
High Street and Closes East,
501
425
—
76
17
1
vjrre6Dnea.Q ana. j-iOnQon xYOdtu,
4,461
4,752
291
—
o
8
Barrowfield, ...
2,672
2,543
—
129
9
Monteitn Kow,
174
172
—
2
Ob. -£l.OCllcW kjUUctlt?, ... ...
216
173
43
i 1
Oalton,
1,957
1,593
—
364
12
St. Enoch Square, ...
133
74
—
59
Id
Brownfield, ...
128
135
7
1 A
14
Bridgegate and Wynds,
555
237
—
:'. is
10
Woodside,
2,156
2,245
89
—
16
Cowcaddens,
1,464
1,473
9
—
17
Kelvinhaugh and Sandyford,
359
392
33
—
18
Anderston, ...
1,854
],650
204
19
Kingston,
1,482
1,249
233
20
Laurieston, ...
481
437
44
21
Hutcheson Square, ...
4,086
4,277
191
22
Gorbals,
752
580
172
Springburn and Rockvilla.
1,537
1,909
372
Empty Houses.
Within the area of Old Glasgow in 1891, 5,440 houses, or 4 4 per cent, of the
total, were unoccupied on the night of the Census ; in the added Listricts, 1,223,
or 6'6 per cent., were unoccupied, together forming 4"7 per cent, of the total
number of houses within the whole area. At the present Census, 7,274 were
unoccupied, which is 4 5 per cent, of the total.
It is unfortunate that the returns cannot be made to convey information
regarding the size of these.
Within the area of Old Glasgow at the present Census the number of empty
houses was 5,427, or 4'i per cent. ; in the added Districts they numbered 1,847,.
or 6 "3 per cent., proportions which do not vary much from these obtaining in
1891. In 1881 the proportion of empty houses was 10 per cent. ; in 1871, 2
per cent.
30
Formula for Calculating the Annual Increase, 1901-1911.
During the intercensal period 1891-1901, the Annual Estimates of the
3)opulation, based on the rate of increase in the previous decade and on the
number of inhabited houses returned by the City Assessor in June of each year,
differed very little from each other. In the earlier years of the decade, the
estimate based on inhabited houses was somewhat lower than the other, but
the difference gradually inclined the other way, until in 1900 the Medical Officer's
estimate exceeded that of the Kegistrar-General by 11,761. For 1901* it would
have exceeded the Census by 900, but as this assumed the shipping population of
1891 as constant, the actual difference would have been about 1,500. The result,
therefore, has once more established the superiority of a method based upon data
which can be obtained with a fair degree of accuracy each year over one which
is based on conditions which may be very widely departed from when it comes to be
applied. The close approximation of recent results is no doubt largely attri-
butable to the annexation of the outer ring in November, 1891, which, as we have
seen, preserved to the City its natural increase, although it may be partially
explained by a steadier growth of the population in recent years.
The method of calculating the population on the basis of the number of
" ^Inhabited Houses " was fully discussed in the Census Report for 1891, and we
need only consider here the alterations which have occurred in the factors
employed. At the Census of 1891 the average number of persons per house was
found to be 4-778, and this at the Census of 1901 had fallen to 4-769.
In June, 1901, the number of " Inhabited Houses " as returned by the
City Assessor was 159,988, or 4,584 in excess of those found occupied at the Census.
After allowing for the natural increase of the City during the intervening
quarter, there remains a difference of about 2 5 per cent, to be accounted for chiefly
by houses tenanted but not occupied on the Census day. This difference has been
allowed for in the Annual Estimates of the past decade by deducting 1-5 per cent,
from the Assessor's Return, and, though the data at command might suggest a
larger allowance, no change will for the present be made, so that the formula for
the annual estimate of the population during the current decade will be : —
[(Tenanted Houses — IJ per cent.) x 4*769] Shipping -|- Institutions = Population.
Average Rent of House per Year and of Room per Week.
Mr. Henry has kindly supplied me with information from which the follow-
ing approximate average rentals have been calculated for 1901 ; the figures referable
to former years being recast from earlier Census Reports : —
Number of Average Rent of
Year. Total Rental. "fj^on Windowed House Room
Rooms. per Year. per Week.
1881, ... — ... _ ... _ ... £11 6 9 ... —
1891, ... £1,793,255 ... 142,985 ... 348,858 ... 12 10 9-98 ... Is. llfd.t
1901,+ ... 2,162,920 ... 158,779 ... — ... 13 12 3 ... 2s. Oid.
* See note thereon in Annual Report of Medical Officer of Health for 1899-1900.
t The average weekly rent per room in old Glasgow in 1891 was Is. 9Jd.
t These figures apply to houses alone, but there were, in addition, 3,040 combined houses and
shops yielding a rental of £50,826, which are excluded from the calculation of average rentals. The
increase in the average rent per house is, in part at least, related to the increase which we have seen
to have occurred in the size of the average house ; but the increase in the average room rental quite
definately indicates that for corresponding accommodation the rent paid has risen during the
decennium.
31
Glasgow's Outer Ring.
The outer ring of population surrounding Glasgow proper, which the Registrar-
General in 1881 first constituted into a Principal Town District as " Glasgow
Landward and Suburban" is described in his 27th Detailed Annual Report as
consisting of the landward parts of the City (Registration) Districts, together with
the Registration Districts of Cathcart, Eastwood, Mary hill, Govan, and Partick.
The inclusion of a considerable portion of the population of this area within
the City boundary by the extension of 1891 has terminated the existence of the
outer ring as thus constituted, but the rate at which the population around Glasgow
is increasing may be deduced from a comparison of the rate of growth of the
combined population of the civil parishes within which the registration districts
just mentioned were contained, and adding thereto that of Rutherglen. These
approximately represent the total population within a radius of four miles of the
Exchange.
The population in 1891 and 1901 was as follows; —
Parishes.
1891.
1901.
Glasgow,
486,636
571,569
Govan,
286,281
34L443
Eastwood,
16,042
18,886
Cathcart,
16,589
28,358
Rutherglen,
16,178
21,012
Total,
82L726
981,268
We have thus a numerical increase during the decennium of 159,542, repre-
senting a rate of 19-4 per cent, for the whole population within the four-mile radius,
or 3-6 in excess of the rate per cent, of increase within the Municipal boundary.
Proposed Change from Present Sanitary Districts to Municipal Wards.
The present Sanitary Districts were formed in 1871, when Sir William T.
Gairdner was Medical Officer of Health for Glasgow. The history of the
various attempts to sub-divide the City so as to " exhibit the local variations in
our vital statistics " is contained in Part I. of the " Vital Statistics of Glasgow,"
by Dr. Russell, late Medical Officer of Health of the City, i'rom the account
there given, it appears that the present sub-divisions were a compromise
between the ten Registration Districts of the City then existing, and which,
" embracing a population of 30,000 to 40,000, were too large," and an earlier
proposal "that the 960 Enumeration Districts of the City, formed for the
purposes of the Census of 1861, might be taken as the basis." The complexity
of this latter scheme proved a barrier to its realisation, and although some use was
for a time made of another proposal, which had been submitted to the Board of
Police in 1865, for dividing the City into 54 districts, these also were, for the most
part, soon abandoned. Recourse was then had to the Registration Districts, and
32
finally, in 1871, these were sub-divided into the present Sanitary Districts. The
following Table shows the scheme of division, the numbers only of the Sanitary
Districts being given : —
Old Registration Districts. Sanitary Districts.
Central, ... ... ... ... 1, 2, 3, 4.
High Church, ... ... ... 5,6.
Bridgeton, ... ... ... ... 7, 8.
Calton, ... ... ... ... 9, 10, 11.
Clyde, ... 12, 13, 14.
Blythswood, ... ... ... ... Bl.
Milton, ... ... ... ... 15, 16.
Anderston, ... ... ... ... 17, 18.
Tradeston, ... .. ... ... 19, 20.
Hutchesontown, ... ... ... 21, 22.
Maryhill (part), ... ... ... Rv.
Springburn (part), ... ... ... Sp.
This scheme had in it the merits and defects of a compromise. By making
the Sanitary Districts sub-divisions of the Registration Districts the statistical
work of the Department was simplified, and the possibility of a fontinued error
in the estimate of their populations could be avoided by comparison with the
recurring Census Returns of each Registration District. The chief defect lay
in the arbitrary character of the boundaries of the sub-divisions imposed by
the limits of the Registration Districts. These latter had not been arranged
for sanitary purposes, and though an eifort was made within the limits thus
prescribed to make each of the sub-divisions as homogeneous in its social con-
dition and sanitary circumstances as possible, it was in the nature of things
only partially successful. In 1875 the Registration Districts were completely
rearranged, and any advantage gained by subordinating the Sanitary Districts
to them was lost, but very wisely no attempt was then made to remodel these latter,
for they had already proved most serviceable, and were destined in the next
quarter of a century to exercise a powerful influence on the sanitary history
of Glasgow.
Great changes have passed over the City since these Sanitary Districts
were formed. The various improvement schemes and railway extensions have
transformed many of the old plague-spots of the City, and swept away not
a few of its historic slums, so that districts like the notorious No. 14, which
in these early days of sanitation were a synonym for all that was insanitary and
unhealthy, are now rapidly approaching the average death-rate of the City.
This transformation is reflected in the movements of the population as shown
in the following Table, which, for obvious reasons, relates only to Old.
Glasgow : —
33
Population.
Sanitaby Districts.
1871.
1881.
1891.
1901.
Percentage, Increase and
Decrease, 1871-1901.
L^, X>llU^cga»UtJ ciLLijL vv y iiyjiaj ... ...
12. St. Enoch Square, ...
6. High Street and Closes East,
14,294
7'807
17,532
7,798
3*660
7,745
5,689
3,458
7,487
3,880
3,000
7,102
|> Over 50 decrease.
10. St. Andrew Square,
8,026
4,151
4,418
4,794
Over 40 "/^
il\J, J-JdjUilCoLUxlj ■•• ... ■■•
3. High Street and Closes West,
22. Gorbals,
12,305
12^621
16,811
9,131
10,058
13,156
9,108
9^356
13,544
8,986
9,669
13,096
j. Over 20 7^
X>iy ullo WUUQj ... ... ...
11. Calton,
33.442
25,637
26 789
22'094
28,543
22^637
28,548
22'l69
1 Over 10 7„
18. Anderston, ...
V3» JL-Jdrl 1 LI W ll<:71Uj ... ... ... - - .
1. Exchange,
Q TVrnnf pitVi T^nw
JJJ.\Jl±VCHjLl XliU W , ... ... ...
16. Cowcaddens,
31,630
30 108
26,354
4,513
19'270
29,031
28 807
20^617
4 914
15^233
29,670
26,944
21^663
4,643
16^235
28,858
27,696
24,431
4,267
18^206
)
I Under 10 7„ „
2. Port-Dundas,
L fJi J_>A \J vv lliidvj.j ... ... ... ...
19. Kingston,
5,305
3 702
36^897
4,704
3 826
37^935
4,678
3 797
4M13
5,346
3,924
40^407
j. Under 10 " j increase.
4. St. RoUox,
12,988
14,252
15,751
15,907
Over 20
17. Kelvinhaugh and Sandyford,
21,083
26,628
30,523
32,234
Over 50
21. Hutcheson Square, ...
38,811
54,704
63,493
70,229
Over 80 7.
5. Bellgrove and Dennistoun, ...
40,938
54,195
63,348
79,211
Over 90 7^
7. Greenhead and London Road,
30,520
44,795
52,747
66,197
Over 100 "/^
15. Woodside, ...
— Springburn and Rockvilla, ...
27,116
12,732
45,080
22,217
58,609
28,278
70,145
35,527
1 Over 150 7^
In this summary the districts are arranged in order, beginning with those
showing the largest decrease, and the result is to bring out in bold relief
the revolution which they have undergone. This is further illustrated by the =
following comparison : —
Number of Districts.
District Populations. 1871. 1901.
Over 70,000, ... ... — ... ... 3
60,000 to 70,000,... ... — ... ... 1
50,000 to 60,000, ... ... — ... ... —
40,000 to 50,000,... ... 1 ... ... 1
30,000 to 40,000,... ... 6 ... ... 2
20,000 to 30.000,... .... 4 ... ... 5
10,000 to 20,000,... ... 8 ... ... 3
Under 10,000, ... ... 5 ... ... 9
In both 1871 and 1901 seven of the districts had populations exceeding
30,000 ; but whilst in 1871 only one district had a population exceeding 40,000, now
four have populations exceeding that number, and three of these have populations
exceeding 70,000. By contrast, while formerly only five districts had populations
under 10,000, now there are nine such. It is manifest that some of the present
districts have overgrown the limits of suitability for sanitary statistical purposes,
and local knowledge indicates that whatever claim to homogeneity they at one time
possessed has been almost entirely lost. For both reasons it seems desirable to alter
the present arrangement either partially or wholly, and the present time is particularly
34
opportune for tlie consideration of the question. Two methods of dealing with
it suggest themselves. We may retain the present divisions, grouping those
which have become too small and sub-dividing those which have outgrown
their usefulness, or we may substitute a scheme of sub-division of the City on
entirely different lines. If the former plan is adopted, Districts 3 and 6, 9 and
10, and 12 and 14 suggest themselves as convenient combinations, while the larger
districts, some of which have grown to the proportions of considerable towns, could be
some of which have grown to the proportions of considerable towns, could be
sub-divided so as to produce Sanitary Districts of moxB reasonable size. But
there is much to recommend a complete change of basis for these sub-divisions ;
and the quickening of local interest in every detail of communal life points to
the Municipal Ward as affording the limits within which these may be recast.
Vital statistics gain much both in interest and value when viewed in the light of
an intimate knowledge of the local circumstances which influence them, and a
Ward death-rate would afford a standard by which its least sanitary areas
might be compared. It is probable also that the present Hegistration Districts
of the City will, ere long, require revision, and if this is done, there can be
little doubt that the present Municipal Wards will form the basis of the recon-
struction scheme. The only objection which can be urged against this pro-
posal is that continuity in our vital statistics will for a time be broken;
but in view of the changes which have taken place in the present Districts
within the last thirty years, this objection loses much of its force. As it
is expected that the Census Reports will in future furnish information
as to the Wards which has hitherto only been given for the City as a whole
(and which it has been impossible to abstract in the limited time during
which the special staff of this Department is permitted access to the enumeration
books), investigations of considerable importance- — ^as, for example, into occupational
death-rates — which are now impossible, might be pursued with advantage. This
would not, however, lessen the need for the facilities which have been afforded us
at each Census since 1871, because it will still be necessary to sub-divide the larger
Wards, and the data for the sub-divisions can only be obtained from the enumera-
'tion books as hitherto.
The first question to be considered is the population of the Wards, and, by
adopting a grading similar to that already used for the Sanitary Districts, we have
the following series — the figures for the present Sanitary Districts being added
for comparison : —
Population.
Wards.
Sanitary Districts.
Number.
Average
Population.
Number.
Average
Population.
Over 50,000,
1
53,476 ■
4
71,445
40,000 to 50,000, ...
4
42,835
1
40,407
30,000 to 40,000, ...
11
34,768
3
34,473
20,000 to 30,000, ...
4
26,145
7
25,227
10,000 to 20.000, ...
3
14.089
5
14,977
Under 10,000,
2
3,801
13
6,202
Average for City.
30,468
35
From these data it will be seen that the Wards, sub-divided as proposed, will
form as suitable districts as any that can be produced by a rearrangement of those
presently existing.
If, as a general principle, the adoption of the Municipal Ward as the basis of
future statistics commends itself, a plan of sub-division will require to be
formulated, which, while maintaining fairly comparable numerical proportions,
will aim at a certain uniformity of social conditions and surroundings. District
14 formerly had these qualities; Districts 13, 16, and Kelvinside now present
them ; but Blythswood, Monteith Row, and Bellgrove and Dennistoun have each
populations living under conditions as diverse as those presented by the City itself.
In view of a rearrangement on the lines here suggested, the whole details of
housing and population already dealt with in relation to the present Sanitary
Districts have been recast for the several Municipal Wards, and form Tables VIII.
to XIV. of the Appendix.
\
APPENDIX.
38
TABLE I.— Glasgow: Acreage; Comparative Statement of Population; Houses (Inhabited and Empty)
AND per Windowed Room; and Percentage of Irish Born at thi
POPULATION.
SANITARY DISTRICTS.
Acreage.
Without Institutions
and Shipping,
Institutions.
Shipping.
Total.
Difference of Total
Populations.
1901.
1891.
1901.
1891.
1901.
1891.
1901.
1891.
1901.
Increase.
Decrease.
BLYTHSWOOD, ...
266
28,438
28,016
105
532
28,543
28,.548
5
1.
EXCHANGE,
215
19,983
22 212
1,680
2,219
21,663
24,431
2,768
2.
PORT-DUNDAS,
73
4,655
5,. 326
23
20
4,678
5,346
668
3.
HIGH STREET AND CLOSES WEST,...
42
9,223
8,827
133
842
9,356
9,669
313
4.
ST. ROLLOX,
45
15,751
15,903
4
15,751
15,907
156
5.
BELLGROVE AND DENNISTOUN,
1,327
62,208
77,923
1,140
1,288
63,348
79,211
15,863
6.
HIGH STREET AND CLOSES EAST, .
50
5,6.35
5,037
1,852
2,065
7,487
7,102
385
7.
GREENHEAD AND LONDON ROAD,
897
51,787
65,090
960
1,107
52,747
66,197
13,450
8.
BARROWFIELD
123
26,944
27,696
26,944
27,696
752
9.
MONTEITH ROW
115
4,643
4,267
4,643
4,267
376
10.
ST ANDREW SQUARE,
KJ A • Xi.Ait JUr AIL Aj ■ ¥ w A A Aft AJ) • • • • • • ■ ■ •
22
4,124
4,010
294
784
4,418
4,794
376
11.
CALTON
66
21,747
20,640
890
1,5-29
22,637
22,169
468
12.
ST. ENOCH SQUARE,
84
3,429
2,376
576
29
48
3,458
3,000
458
13.
RROWNFIELD . .
JJXIW V¥ Xl A X J_JAJA/) ••• ••■
11
3,451
3,564
337
316
9
44
3,797
3,924
127
14.
BRIDGEGATE AND WYNDS, ...
35
5,689
3,766
114
5,689
3,880
1,809
15.
WOODSIDE
336
58,257
69,787
352
358
58,609
70,145
11,536
16.
COWCADDENS,
61
16,2.36
17,550
656
16,235
18,206
1,971
17
KELVINHAUGH AND SANDYFORD.
°* » ' 1 J T AX¥ XaXA W VI A A ZA J.¥ Ar AA\ A' A A Al. A' 9 - ■ '
626
29,538
30,673
642
880
343
681
30,623
32,234
1,711
18.
ANDFR'^TON
127
29,251
28,422
361
349
58
87
29,670
28,858
812
19.
KINGSTON,
389
40,863
40,079
45
205
328
41,113
40,407
706
20.
LAURIESTON,
49
8,850
8,662
179
311
79
13
9,108
8,986
122
21.
HUTCHESON SQUARE,
453
63,493
70,127
102
63,493
70,229
6,736
22.
GORBALS,
48
13,199
12,264
345
832
13,544
13,096
448
—
SPRINGBURN AND ROCKVILLA,
866
28,278
35,527
28,278
35,527
7,249
23.
GOVANHILL,...
360
17,014
23,191
17,014
23,191
6,177
OA
vXlUooxllLilj, ...
4,320
7,626
4,320
7,626
3,306
25.
LANGSIDE AND MOUNT FLORIDA, ...
420
9,141
14,487
196
360
9,337
14.847
5,510
26.
POLLOKSHIELDS AND STRATHBUNGO.
243
9,869
12,830
9,869
12,830
2,961
27.
POLLOKSHIELDS, WEST, AND BELLA-
HOUSTON,
1,278
3,538
5,711
3,538
5,711
2,173
28.
HILLHEAD,
130
7,738
8,537
7,738
8,537
799
29.
KELVINSIDE,
765
5,526
7,074
.664
716
6,190
7.790
1,600
30.
MARYHILL,
1,183
16,798
33,661
1,528
1,980
4
16
18,330
35,657
17,327
31.
POSSILPARK AND BARNHILL,
1,642
14,908
20,263
1,097
1,431
16,005
21,694
5,689
Totals within Municipal Boundary.
12,681
644,623
741,124
12,800
19,347
760
1,241
658.073
761,712
103,639
1
3a
riNDOwED Rooms (Total Number and Number per House); Persons peh Acre; per Inhabited House,
Exsus Periods, 189T and 1901, in each Sanitary District.
HOUSES.
WINDOWED ROOMS.
PERSONS PER 1
Percentajie of
1891.
1901.
1891.
1901.
Number per
Inhabited House
(exchiding In.sti-
tutions and
Shipping).
Acre (includins
Institutions and
Shipping).
House (exclud-
in<r Institutions
and Shipping),
Room (exclud-
ing Institutions
and Shipping).
Irisli born.
(Whole Popula-
tion.)
E ni ]i t y .
Inlitibited.
Empty,
Inhabited
Houses.
Institu-
tions.
Inhabited
Houses.
Institu-
tions.
1891
1901.
1891.
1901.
1891.
1901.
1891.
1901.
1891.
1901.
.3,537
276
5,360
154
22,568
36
21,956
771
4-076
4 096
107
107
5-136
5-2-27
1 -260
1
1 -276
4-73
5-39
Bl.
-J, 002
285
4,458
181
11,834
386
12,387
435
2-957
2-779
101
114
4-993
4-983
1-689
1-793
6-95
6-74
1.
977
47
1,140
234
1,830
2,072
1-873
1-818
64
73
4-765
4-672
2-544
2-570
14-37
12-31
2.
1,867
91
1,889
110
3,803
44
3,808
216
2-037
2-016
223
230
4-940
4-673
2-425
2-318
1114
7-73
3.
3.279
86
3,334
107
6,541
6,705
1-995
2-011
350
.353
4-804
4-770
2-408
2 -.372
10-44
9-71
4.
13,092
517
16,429
777
30,071
296
37,902
346
2-297
2-307
55
60
4-752
4-743
2-069
2-056
9-64
8-41
5.
1,205
104
1,105
48
2,240
637
2,088
721
1-859
1-890
150
142
4-676
4 -558
2-516
2-412
15-21
12-73
6.
11,288
367
13,959
616
20,160
288
25,466
377
1-786
1-824
62
74
4-587
4 663
2-569
2-556
9-26
8-26
7.
(i,2.35
555
6,273
307
10,445
10,786
1 -675
1-719
219
225
4 -.321
4-415
2-580
2 568
12-29
1005
8.
936
30
842
36
2,861
2,502
3-057
2-971
40
37
4-960
5 068
1-623
1 -705
9 76
7-87
9.
814
43
751
32
1,973
9
1,819
240
2-424
2 422
201
218
5-066
5-340
2-090
2-205
16-00
13-73
10.
4,989
281
4,616
303
8,895
41
8,523
48
1-783
1-846
343
336
4-359
4-471
2-445
2 -422
12-40
10-36
11.
635
80
438
16
2,399
1,565
298
3-778
3-573
41
36
5-400
5-425
1-429
1-518
12 -23
15-23
12.
696
22
683
38
1,482
14
1.427
16
2-129
2 089
345
357
4-958
5-218
2-329
2-498
17-41
19-37
13.
1,110
158
773
19
2,110
1,700
12'
1-901
2-199
163
111
5-125
4-872
2-696
2-215
23-26
14-28
14.
12,444
567
14,882
572
32,698
11
39,273
11
2 -6-28
2-639
174
•209
4-682
4-689
1-782
1-777
6-25
5-69
15.
O, DDI
ouy
\>,oo-±
D, WU
1 735
1-762
266
296
4-447
4 568
2-563
2 -592
18-54
14-80
16.
OOQ
— ijt7
D, --oO
Mi
OO Alii
3-765
3-699
49
51
4-921
4919
1-307
1330
5-88
631
17.
D, ioy
I/O
1 *i
16
17
2-005
2-035
234
— — /
4-742
4-791
2-365
2-355
16-91
15-84
18.
^Ql
41
22,083
2-646
2-691
106
104
4-817
4-885
1-820
1-815
6-97
712
19.
1 856
76
66
7
O,0i'0
2-098
lab
183
•4-768
4-919
2-274
2 344
12-87
1 3 "83
20.
13,866
474
15.168
505
27,097
29,689
19
1 -954
1 -957
140
155
4-579
4-623
2-343
2-362
8-73
8-34
21.
2,722
106
2,444
93
5,698
18
5,250
36
2 093
2-148
'282
273
4-849
5-018
2-316
2 3.36
16-36
14-84
22.
5,699
218
7,379
288
11,003
14,255
1-931
1 -932
33
41
4-962
4-815
2-570
2-492
15-24
13-05
S.&R.
3,483
129
4,987
175
9.677
12.972
2-778
2 601
54
64
4-8S5
4-650
1-758
1-788
4 16
23.
851
64
1.597
97
4,319
6,952
5-075
4-353
13
23
5-076
4-775
1-000
1-097
2-82
24.
1,786
215
3,100
264
8.547
113
13,527
274
4-786
4-364
22
35
5-118
4-673
1-069
1071
2-51
25.
1,951
146
2,756
183
9,626
1.3,032
4-934
4-729
41
53
5-058
4-655
1-025
■984
2-07
26.
559
32
946
57
5.396
8,118
9-653
8-581
4
4
6-329
6-037
1-656
-703
2 71
27.
1,585
156
1.742
94
10,137
11,213
6-396
6-437
60
66
4-882
4-901
-763
-761
2-18
28.
926
84
1,213
108
8,944
525
11,132
441
9-659
8-956
S
10
5-968
5-691
-618
-635
2-79
29.
3,268
238
7,145
652
9,046
417
18,811
848
2-768
2-6.33
15
30
5-139
4-711
1-857
1-789
12 68
30.
2,9lS
169
3.990
217
6,509
176
8.935
85
2-2.30
2-239
11
13
5-107
5-078
2-290
2 -268
10-82
31.
134,882
6,663
155,404
7,274
345.549
3,. 309
401.543
5.695
2 562
2-584
.55-48
60-07
4-778
4-769
1-865
1 -846
10-19*
8 -68
Applies to Old Glasgow.
40
TABLE II.— CENSUS, 1901— GLASGOAV: AGE AND SEX OF THE POPULATION IN SANITARY DISTRICTS
SANITARY DISTRICTS.
BLYTHSWOOD,
EXCHANGE
2. : PORT-DUNDAS,
3. I HIGH STREET AND CLOSES
I WEST,
4. ST. ROLLOX,
5. BELLGROVE & DENNISTOUN,
6. HIGH STREET AND CLOSES
EAST,
7. GREENHEAD AND LONDON
ROAD,
8. BARROWFIELD,
9. MONTEITH ROW,
10. ST. ANDREW SQUARE, ...
1 1 . CALTOW,
12. ST. ENOCH SQUARE,
13. BROWNFIELD,
14. BRIDGEGATE AND WYNDS,
15. WOODSIDE,
16. COWCADDENS,
17- KELVINHAUGH AND SANDY-
FORD,
18. ANDERSTON,
19. KINGSTON,
20. LAURIESTON
21. HUTCHESON SQUARE,
22. GORBALS
— SFRINGBURN & ROCKVILLA,
23. GOVANHILL,
24. CROSSBILL,
25. LANGSIDE & MT. FLORIDA,
26. POLLOKSHIELDS & STRATH-
BUNGO,
27. POLLOKSHIELDS, WEST, &
BELLAHOUSTON,
28. HILLHEAD,
29. KELVINSIDE,
30. MARYHILL,
31. POSSILPARK & BARNHILL,
/Without Institutions,
\Institutions,
rWithout Institutions,
\lnstitutions,
/Without Shipping,
\Shipping,
/Without Institutions,
\Institutions,
/Without Shipping,
\Shipping,... _ ...
/Without Institutions,
/Institutions,
/Without Institutions,
/Institutions,
/Without Institutions,
\lnstitutions, ...
/Without Institutions, ...
/Institutions,
r Without Institutions, . . .
(^Institutions,
(Without Insts. & Shipping,
Institutions,
Shipping,
{Without Insts. & Shipping,
Institutions,
Shipping, ...
/Without Institutions, . . .
/Institutions,
/ Without Institutions, . . .
/Institutions,
f Without Institutions, . . .
/Institutions,
{Without Insts. <fe Shipping,
Institutions,
Shipping, _ _ ...
(Without Insts. ife Shipping,
Institutions,
Shipping,
/ Without Shipping,
/Shipping,
{Without Insts. & Shipping,
Institutions,
Shipping,
/Without Institutions, . . .
/Institutions,
/Without Institutions, ...
/Institutions,
/Without Institutions,
/Institutions,
/Without Institutions, ...
/Institutions,
f Without Insts. & Shipping,
-! Institutions,
[Shipping,
/Without Institutions, ...
/Institutions,
Total without Institutions and Shipping,
Total Institutions, ...
Total Shipping, ... ...
Total within Municipal Boundary,
1 All Ages.
Under 1 Yeae.
j Males.
Females.
Total.
Males.
Females.
Total.
1
13,414
14,602
2S,0]6
191
207
398
321
211
532
2
3
5
11,068
11,144
22,212
303
299
602
1,121
1,098
2,219
22
12
34
2,767
2,559
5,326
115
97
212
20
20
4,333
4,494
8,827
123
128
251
582
260
842
...
2
2
8,028
7,875
15,903
225
236
461
4
4
38,188
39,735
77,923
1,232
1,164
2,396
711
577
1,288
1
1
2,452
2,585
5,037
57
64
121
1,661
404
2,065
5
1
6
31,935
33,155
65,090
1,139
1,088
2,227
439
668
1,107
3
12
15
13,298
14,398
27,696
438
457
' 895
1,994
2,273
4,267
39
36
75
1,970
2,040
4,010
44
51
95
6i'0
164
784
1
1
9,907
10,733
20,640
336
288
624
1,260
269
1,529
1
1
1,280
1.096
2,376
14
16
30
487
89
576
48
48
1,769
1,795
3,564
51
53
104
314
2
316
44
44
1,883
1,883
3,766
58
60
118
80
34
114
33,489
36,298
69,787
914
923
1,837
352
6
358
8,685
8,865
17,550
260
262
522
654
2
656
14,290
16,383
30,673
328
312
640
451
429
880
1
1
676
5
681
14.490
13,932
28,422
419
425
844
347
o
349
84
3
87
19,842
20,237
40,079
462
447
909
326
2
328
4,436
4.226
8,662
124
109
233
311
311
13
13
34,339
35,788
70,127
1,082
1,035
2,117
52
50
102
1
3
4
6,216
828
6.048
12,264
171
164
335
4
832
18,407
17,120
35.527
568
587
1,155
11,391
11.800
23,191
357
315
672
3,365
4.261
7,626
58
71
129
6,382
8,105
14,487
135
170
305
153
207
360
1
1
5,472
7,358
12,830
80
94
174
2,276
3,435
5,711
35
28
63
3,089
5,448
8,537
38
42
80
2,382
4,692
7,074
48
49
97
227
489
716
16;541
17,120
33,661
569
591
1,160
968
1,012
1,980
8
7
15
16
16
10,301
9,962
20,263
358
319
677
686
745
1,431
7
15
22
359,679
381,445
741,124
10,371
10,187
20,558
12,625
6,722
19,347
52
56
108
1,231
10
1,241
373,535
388,177
761,712
10,423
10,243
20,666
41
aSTINGUISHING THE INMATES OF INSTITUTIONS AND SHIPPING ; ALSO NUMBER OF IRISH-BORN.
1 4.
5 9.
10 14.
15 19.
j Males.
Females.
Total.
Males.
Females.
Total.
Males.
Females.
Total.
ilales.
Females.
Total.
758
775
1,533
1,005
1,022
2,027
1,159
1, 166
>•
2,325
1,539
1,579
3,118
11
13
24
24
13
37
10
6
16
31
21
52
903
846
1,749
1 A O A
1,030
1,068
2,098
1,033
1,042
2,075
Ij 170
1, 146
2,316
72
78
150
57
A
79
136
27
40
67
39
61
294
257
551
o o o
332
281
613
268
313
581
J7b
2 / 1
547
433
471
AA 4
904
522
459
991
442
405
847
1
4D0
460
1
AT A
910
1
1
1
6
7
4
4
8
1 1
34
785
803
1,588
o9d
0*7 0
873
1,769
784
816
1 A A
1,600
o 1 y
f7 £i f*
766
1 c o er
1,085
3,946
3,983
T A .I A
4,4o6
A O f* ^
4,365
8,851
3,91 /
4,055
A o
7,9/2
o,744
3,991
/,735
24
23
4/
45
25
^7 A
70
186
32
218
3o
113
262
240
502
261
268
529
221
268
A OA
489
o o o
238
459
o
3
2
5
12
3
15
OA
oO
19
99
3,619
3,644
7,263
4,004
O O A
3,8/9
7,883
3,487
3,553
7.040
3,323
6,554
12
18
O A
60
OA
20
27
A 'T
47
194
167
361
T A
19
43
62
1 1,402
1,412
2,814
1,613
-1 f* f\ A
1,604
3,217
1,484
1,464
2,948
1,36 /
1,447
2,814
1 131
159
290
191
205
396
194
215
409
224:
250
474
170
166
336
1 / 5
216
391
214
191
405
O Af?
207
213
420
17
10
27
47
A O
48
95
46
49
95
98
O A
30
128
1,030
1,074
O 1 A <
2,104
1,152
1 1 PC O
1,152
2,304
A A
960
1,11 /
2,0/ /
A ^ A
970
1 A PC A
l,OoO
2,020
1
4
5
7
9
7
5
12
35
1 1
46
90
88
1 lb
IIP;
Ho
101
216
96
1 AfT
107
OA O
203
111
111
1 1 A
119
r» o A
230
o
O
3
7
7
46
OA
20
66
* ' *
1
1
7
7
152
167
O 1 A
319
ley
TOO
183
372
166
177
343
1 AA
lyo
168
35o
1
1
1
1
o
0
3
2
177
185
oo2
1 O i
172
356
118
161
279
153
178
331
12
12
3,186
3,166
b,3o2
O K 1 ^
O,0l (
3,o3d
7, loo
o K o
3,5o8
O A
3,45 /
/,015
3,472
3,634
tr 1 A^
7,106
2
1
1
7
9
894
980
1,8/4
1 A Q p;
1 ATO
1,079
2,114
A O O
923
8 / 3
1,796
O O Q
8o8
1,681
1
1
4
1
5
22
1,111
1,136
2,247
1,341
2,683
1,362
1,347
2.709
1 PC 1 1
1,51 1
1,634
3,145
12
7
1 A
24
lb
40
29
16
45
29
54
83
1
1
54
54
1,353
1,384
o oil
2,737
1 K 0 r.
1 Pi 1 o
l,Oib
3,053
1,449
1,405
2,854
1,511
4
1,366
2,877
4
1,594
1,572
o,lbb
1 (\ A ^
1,946
O A 1 1
3,91 1
1,875
1 A A T
1,997
3,872
cc
0
f) f) ^) ^
2,145
5
4,367
36
36
388
409
79/
A Q 4
4o4
A I"! (\
4/9
963
432
472
904
485
432
917
1
1
o
3
3
3,689
3,708
7,397
4,189
4,062
8,251
3,603
3,563
...
7,166
...
3,473
3,567
7,040
7
2
9
8
4
12
10
9
19
5
8
13
558
529
1 rt u ^7
644
boi
1 o A p;
1,305
603
639
1,242
631
633
1,264
10
1
11
1,903
2,002
O A A K,
1 A ^
2, 1 41
O A ^ A
A 1 O 1
4,181
1,820
1,934
3,754
1,812
1,659
3,471
1,135
1,113
2,24o
1,318
1,246
2,564
],214
1,170
2,384
1,154
1,153
2,307
229
227
456
310
316
626
348
329
677
O A
369
501
870
571
568
1,139
^1 A
714
708
1,422
637
692
1,329
623
917
1,540
6
4
10
31
27
58
40
39
79
16
26
42
395
369
764
513
498
1,011
529
521
1.050
568
884
1,452
146
144
290
224
200
424
237
250
487
259
459
718
152
135
287
244
226
470
267
274
541
369
591
960
173
155
328
221
242
463
214
260
474
239
431
670
1
1
2
5
7
3
38
41
1,872
1,896
3,768
1,900
1,899
3,799
1,630
1,651
3,281
1,533
1,558
3,091
101
1 el's
126
/
^ i o
224
i i J
1,214
2,334
1 31 3
1,271
2,584
1,149
1.133
2,282
1,032
2,086
23
19
42
18
17
35
10
6
16
15
13
28
34,621
34,977
69,598
39,745
39,245
78,990
36.393
37,017
73,410
36,780
38,653
75,433
287
274
561
411
420
831
654
600
1.254
785
483
1,268
2
...
2
105
105
34,908
35,251
70,159
40,156
39,665
79,821
37,049
37,617
74,666
37,670
39,136
76,806
42
TABLE II.-
20 24.
25 34.
SANITARY DISTRICTS.
T^'pTTia 1 PR
Total.
ATa 1 pe
n PTn £) 1p%
Tntpl
—
BLYTHSWOOD,
1 VVltllUUU -LUoLlLUL'lUIlbj ...
1 TTi'=N't",Thnf,irtnci
2,098
56
1.954
64
4,052
120
2,599
86
2,724
63
5,323
14£
1.
EXCHANGE
1 VVlUXlUUb J-UoL/luuDlUIlSj ...
1,464
1.312
2,776
2,003
1,939
3,94?
iiO L/i- L/ U. UJ.'k-'XJ.Oj ... ...
30
73
103
106
141
217
2.
PORT-DUNDAS,
1 W/ 1 TrM'tTi'i' Ssrn tm^t n rr
1 vviuiiuuu tjiiippiii<^j ...
278
263
541
453
385
83S
\Shipping, ...
5
5
7
1
3.
HIGH STREET AND CLOSES
(Without Institutions, ...
451
392
843
717
758
1,47c
WEST,
I TnstitntioTT^
40
14
54
105
58
162
4.
ST. ROLLOX,
J Without Shipping,
879
818
1,697
1,413
1,305
2,716
^^Shippmg, ...
1
1
BELLGROVE & DENNISTOUN,
I VV lUllUUU XXlbLlLUljlOnSj
l^lnstitutions, ... ...
4,001
4,074
8.075
6,719
6,788
13,50'i
5.
55
121
176
85
112
m
6.
f Wi f", n mi T. Tn cif",! i",n f,! nn a
1 TV LVJ.1\JKX V JlXIO U± U Ul UJ.VJXl0j . . .
243
258
501
469
461
93C
EAST
1 XllouiuU.L'lULIbj ... ...
153
71
224
398
145
542
7.
y^A^ithout Institutions,
3,158
3.308
6.466
5,411
5,419
10,83(
ROAD,
1 XIAO U± U U. uH_'J_Lo, ... ...
42
94
136
86
180
266
8.
BARROWFIELD,
1,280
1,373
2,653
2.072
2,135
4,207
9.
MONTEITH ROW,
249
274
523
319
348
667
10.
ST. ANDREW SQUARE, ...
f Without Institutions, . . .
1 J.nbUitU.UlOllb. ... ...
222
223
445
323
329
655
43
7
50
81
8
8J
11.
CALTON
J Without Institutions, . . .
I TnRtitntTOTi*?
1 -L AAO UA U W UAv/AAO^ ... ...
957
1,030
1,987
1.624
1,646
3,27(
51
6
57
236
31
26'-
^Without Insts. & Shipping,
175 ,
118
293
263
170
43:
12.
ST. ENOCH SQUARE,
1 iTic'TTrn'l"! /~m o
JLaJ o (jJL UU UlUiXo, ... ...
64
42
106
129
21
15(
1 ftnTnTtiTio"
1 kJ LXA 1^ L^A AA^: . ... ... ...
2
■1
18
1^
z' Vv I'i'ririn't" Xna't'c ATSsrnnTM*n*Y
J VV L ullU U- u iXlo uo. 136 Olll IJ UlJjy ,
191
172
363
282
279
56]
13.
Institutions. ... ...
15
15
70
1
7]
1 SinTrniiTio*
^KJAIA^^AAA^, • • • ... ...
9
9
11
1]
14.
BRIDGEGATE AND WYNDS,
( W^ithout Institutions,
275
200
475
390
371
76]
1 TTT^tltntlOTl^
1 -A AAo UA U U. UAv./AAo, ... ...
7
3
10
10
7
r
15.
WOODSIDE
f Without Institutions, . . .
\ Institutions, . . . , ...
3,670
26
3,873
7,543
26
5,917
78
6,462
12,37c
li
16.
COWCADDENS,
r^^itViont Tri'^ititnl'.innci
1 • T A UAAV.f lA V J. AAO UA U H UA wAAO, . . .
{^Institutions,
920
33
856
1,776
33
1,485
144
1,395
2,88(
14^
17.
KELVINHAUGH AND SANDY-
FORD,
j VVIUIIUUU ±nb Lb, oiiipping,
-I Institutions,
1,780
58
1,917
100
3,697
158
2,465
92
3,191
156
5,65(
246
i^oiiipping. . . .
146
146
265
5
27(
1 VV iijnouD ±nst3. 02 snipping,
1.673
1,456
3,129
2,549
2,239
4.786
18.
ANDERSTON
A Institutions, ... ...
19
1
20
71
71
I Sh ipping, ...
10
1
11
25
21
19.
KINGSTON
rW^ithout Shipping,
2,437
2,285
4,722
3,552
3,367
6,9H
Shipping, ... ... ...
67
67
116
2
116
1^ Without Insts. & Shipping,
"i Institutions. ... ...
555
392
947
722
614
1,336
T.ATT'RTF.STOW
22
L'2
74
74
I Shipping
1
1
5
c
21.
HUTCHESON SQUARE,
/Without Institutions,
^Institutions,
3,508
2
3,669
2
7,177
4
6,014
5
6,090
8
12,101
12
22.
GORBALS,
(Without Institutions, . . .
753
650
1,403
1,102
921
2,022
\lnstitutions,
53
53
205
1
2oe
C!PT?T'Nrr4P;nT?Kr ^ PnPTTVTT T A
2,109
1,657
3,766
3,317
2,727
6,041
r* r^TT" A 'MTTTT T
ItU V AJNIxlllili,
1,206
1,245
2,451
2,119
2^179
4,29?
24.
r!T?nSSHTT.T.
... ...
395
537
932
573
821
1,394
25.
LANGSIDE & MT. FLORIDA,
r^Vithout Institutions,
643
885
1,428
1,149
'1,607
2,756
\Institutions,
11
25
36
15
49
64
-jU.
POLLOKSHIELDS & STRATH-
BUNGO,
538
868
1,406
887
1,392
2,279
27.
POLLOKSHIELDS, WEST, &
BELLAHOUSTON,
240
691
931
308
656
964
28.
HILLHEAD,
369
937
1,3U6
524
1,210
1,734
29.
KELVINSIDE,
/Without Institutions, . . .
(Institutions,
[Without Insts. ife Shipping,
243
890
1,133
381
L,287
67
1,668
1 1 9
1,720
1,860
3,580
3,240
3,272
6,512
30.
MARYHILL,
- Institutions,
[shipping,
196
151
347
136
188
324
8
8
6
1,506
/;
0
31.
POSSILPARK & BARNHILL,
(Without Institutions, . . .
1,113
992
2,105
1,643
3,149
(^Institutions,
18
35
53
54
83
-
137
Total without Institutions and Shipping,
39,693
41,429
81,122
63,004
65,993
128,997
Total Institutions, ...
1,013
934
1,947
2,311
1.319
3,630
Total Shipping,
249
1
250
453
7
460
Total within Municipal Boundary,
40,955
42,364
83,319
65,768
67,319
133,087
43
'on tinned.
A 35 44.
45 54.
1 55 64.-
1 13 OKN IN
i[ales.
Females
Total.
Males.
Females
Total.
Males.
(Females
Total.
Males.
Females
Total.
M.
F.
Tl.
j Ireland.
1,562
1,858
3,420
1,246
1,548
1 2,794
826
1,062
1,888
431
705
1, 1 ou
2
2
1,490
55
16
71
25
10
35
13
13
8
2
1 0
48
1,337
1,369
2,706
992
1,041
2,033
585
664
1,249
248
418
666
1,147
148
95
243
159
85
244
204
158
362
274
298
'499
306
289
595
274
211
485
128
113
241
43
79
653
3
3
4
4
5
522
576
1,098
376
374
750
1 94
273
467
103
186
2
2
588
118
43
161
108
28
136
55
23
78
127
71
198
159
990
934
1,924
700
661
1 1,361
369
434
803
168
229
397
1,544
1
1
1
1
1
1
X
1
4,658
4,885
9,543
2,990
3,094
6,084
1,612
2,032
3,644
854
1,265
1 1 9
jJ, lit/
29
39
68
6,367
63
51
114
41
39
80
39
36
75
93
103
196
}
1
'294
332
328
660
217
239
456
] 12
130
242
57
91
413
434
92
526
320
48
368
185
20
205
71
3
74
491
3,665
3,876
7,o41
2,316
2,484
4,800
1,262
1.577
2,839
639
1,002
i J U± i
A
2
«
• 5,384
46
72
118
14
36
50
2
15
17
1
4
Fa
O
85
1,566
1,788
3,3o4
l,lo8
1,259
■2,417
-no
o99
881
1,480
316
578
O t:
O
o
2.783
261
307
568
201
232
433
106
150
256
78
96
1 74-
1
i
1
X
0
336
286
253
539
173
180
353
109
139
348
47
79
1 O
1^0
514
133
5
138
96
98
46
3
49
13
1
1 A
144
1,279
1,374
2,653
865
936
1,801
510
652
1,162
224
413
do t
1
1 937
369
55
424
304
59
363
175
54
229
79
37
LID
360
185
144
329
120
111
231
75
77
152
36
45
o 1
315
104
6
110
82
-••
82
41
41
11
1 1
i 1
139
7
7
7
7
6
6
3
o o o
23o
240
473
198
172
370
90
1 1 9
209
27
65
673
68
68
89
89
46
46
21
o 1
-J 1
83
11
1 1
10
10
1
1
4
OOfi
A o r*
4oD
147
165
312
83
101
184
41
61
1 no
515
15
Q
O
26
14
7
21
17
8
25
5
1
0
39
\ A TOO
t 4, 192
4,0ol
Q 'T.JO
0,7 Jo
a o OA
J,o20
O 1 AA
0,190
6,010
1,506
2.075
3,581
735
1,347
9 08 o
2
A
tt
a
D
3 930
90
1
9o
O 1
81
81
51
51
14
1 ^
60
! 1;U94
1,104
2,19i^
/ 18
735
1,453
391
464
855
142
258
L
1
id, 00 1
loO
loL)
1 f: o
loo
1
154
83
83
34
o-±
xoo
1, / 9o
/,14J
1 o 1 f;
1,010
1,577
2,892
863
1,060
1,923
420
725
1, ittO
1
1
0 /
OO
loo
00
Ci A
24:
90
39
16
55
14
5
1 Q
1 y
1 64
loi
i Jl
52
52
21
21
5
0
1
1
44
1, / /o
1,01 6
o,4oi
1 OOO
l,2o8
1,248
2,486
691
790
1.481
292
426
1 lo
■-)
0
A
t
4 400
I A A
104
A 1
91
1
92
42
42
16
1 0
1 -^Q
O T
Al
1
Y V
lo
1
14
8
8
1
1
1
1
.J 1
4,o4y
.i,4iD
4.7oo
1,700
1,927
3,682
1,129
1,359
2,488
518
755
1 , J / o
0
0
0
9 8*^4
^ A
04
o9
39
13
13
1
1
41
K Q
OoO
L,Ul 6
42o
383
806
204
261
465
79
140'
0 1 Q
0
0
1 , i D i/
oJ
/ 7
77
37
37
15
] f:
1 0
70
2
2
2
o
2
2
1
1
4,080
4,231
8,311
2,642
2,879
5,521
1,417
1,824
3.241
■ 642
1,160
1,802
5,848
7
7
14
4
3
7
o
3
6
1
1
10
787
768
1,555
517
545
1.062
318
367
685
132
171
303
1,722
i
O O 1
-i 24
lyb
1
197
99
99
42
1 0
A A
222
4,1 DO
1 OOA
i,yy(j
A 1 f; f:
4, loo
1 A O X
l,4ho
1,320
2,805
750
772
1,522
337
432
1 by
^, OOo
1 'i.-XA
1,4:00
J, < ( U
ob/
AO/?
986
1.853
476
- 578
1.054
210
379
Ooy
1
1 1
1
y o-i
■i-iO
00/
9bo
O O
3o2
437
769
205
286
491
120
179
OOO
-lyy
01 f;
O / O
1 AQ f;
1 0
K O O
592
613
1.205
322
487
809
218
363
Oo 1
8
22
30
15
11
26
5
2
7
5
o
7
AX)
i yo
1 A7 f;
1,<J/ 0
1 Q ^? Q
1,od6
576
728
1,304
358
483
841
235
446
DOl
266
238
392
630
274
306
580
192
189
381
123
120
243
155
4^U i
/ DO
1,1/0
O o
od2
K p; .1
502
914
210
405
615
147
307
454
1
-1 1
1 1
186
£J 9 Q
000
954
244
376
620
196
21 7
413
J02
152
2Di
1 Rd
1 by
57
61
118
38
88
126
41
57
98
22
47
69
4o
2,037
2,071
4,108
1,184
1,239
2,423
597
684
1,281
259
399
658
4,363
68
1
71
139
1
23
1
15
38
1
17
10
27
5
5
154
1,186
1,143
2,329
796
740
1,536
433
400
833
136
212
348
4
2,001
75
77
152
119
82
201
141
128
269
206
270
476
346 i
43,835
47,010
90,845
30.113
32,488
62,601
16,918
21,105
38,023
8,159
13.283
21,442
47
58
105
62,274
2.539
718
3,257
2,115
540
2,655
1,381
533
1,914
1,076
845
1,921
1
1
3,708
231
1
232
128
1
129
52
52
9
9
2
o
124
46,605
47,729
1
94,334
32,356
33,029
65,385 1
18,351
21.638
39.989
9,244
14,128
23,372
50
58
108
66,106
44
TABLE III.— CENSUS, 1901— GLASGOW : AGE AND SEX OF THE INMATES OF INSTITUTIONS WIT]
All Ages.
SANITARY DISTRICTS.
Name of Institution".
0
r*
Hotel,
127
80
Hotel,
29
48
BLYTHSWOOD, j
Y.M.C.A., 100 Bothwell Street,
Sick Children's Hospital,
121
44
13
70
City Poorhouse, ...
863
804
L
1
EXCHANGE ... ... ]
{
HIGH STREET AND CLOSES WEST, ... j
Fever Hospital, Kennedy Street,
ine JNight Asylum tor txie Houseless, ...
Old Man s Home and Asylum tor Old W omen.
Lodging-House, 173 High Street,
94
164
12G
168
204
90
75
3
I
Do., 195-207 do.,
1
145
Do., 34 Stirling Street,
Central Jrohce Omce,
Slatefield Industrial School,
192
95
175
3
35
2
Glasgow Royal Infirmary,
tet. 0 oseph s Home,
Old Barracks, Gallowgate.
Drygate Model Lodging-House.
xi. M. Irrison, Duke htreet,
Lodging-House, 48 Duke Street.
375
363
5
BELLGROVE AND DENNISTOUN, ... |
f
104
57
365
105
206
137
75
4
314
1
6
HIGH STREET AND CLOSES EAST, ... '
f
Do., 39 Watson Street,
352
Do., 21 do..
Do., 14-16 do.,
Home tor friendless remaies, h Watson Street,
Catholic Orphanage tor Boys, ...
519
111
3
205
1
84
5
7
GREENHEAD AND LONDON ROAD, ... J
[
Do. do. Girls, ...
T-"> 1 • ^ xn XX • j_ 1
Belvidere i ever Hospital,
City Orphan Home,
234
88
208
455
35
10
ST. ANDREW SQUARE, j
(
Lodgmg-House, 4o-49 Greendyke Street,
Family Home, St. Andrew Street,
T 1 • TT /Tn l\ul/^"I\r CIJ. J-
Lodgmg-House (female), 20 Moncur Street, ...
282
250
4
4
125
263
11
CALTON i
I
Do., 0 0 Moncur otreet.
193
Do., i<y Ijrreat Manulton street, ...
Do., 58-o2 Clyde btreet.
700
363
6
12
James W^att Street Home, 22 James Watt St.,
377
2
ST. ENOCH SQUARE, I
Hotel,
110
87
]
13
BROWNFIELD,
Model Lodgmg-House, 28 M'Alpme Street, ...
314
2
14
BRIDGEGATE AND WYNDS,
Lodging-House, 6-14 Miller's Place,
80
34
]
15
WOODSIDE, ;
Lodging-House, 51 North VVoodside Koad.
352
6
16
COWCADDENS, -f
f
Lodging-House, 1 Burns Street,
399
2
4
Do., 16 Garscube Lane,
255
c
Western Infirmary,
253
382
(
17
KELVINHAUGH AND SANDYFORD, ... |
Eye do.,
65
46
]
Clydesdale Model Lodging-House, Cheapside St.,
133
1
]
1 O
ib
ANDERSTON,
Hydepark Model Lodging-House,
347
2
20
LAURIESTON
XT" ■ J "ft /r 1 1 X 1 * TT „ „
Kingston Model Lodging-House,
311
21
HUTCHESON SQUARE,
Sanitary Reception-House, ... ...
52
"50
]
GORBALS 1
Carlton Model Lodging-House
A
41
22
Portugal Street Model Lodging-House,
425
4
4
25
LANGSIDE AND MOUNT FLORIDA, ... /
I
Victoria Infirmary.
iyeai aiiu. jL'u.mu ±iiauituuiuii, ... ... ...
87
66
131
76
]
29
KELVINSIDE, |
Training College,
160
]
Royal Asylum, Gartnavel,
227
329
P
Girls' Industrial School,...
Magdalene Institution, ...
200
102
(T
A
1
30
MARYHILL, -
Eastpark Home, ...
Maryhill Lodging-House,
Ruchill Fever Hospital, ...
"44
98
65
4
1
1
269
497
7
Government Barracks, ...
557
144
7
31
POSSILPARK AND BARNHILL,
Barnhill Poorhouse,
686
745
1,4
Total within Municipal
Boundary, ... ... ... ... ... |
12,625
6,722
19,3
45
L'HE CITY; ALSO NUMBER OF IRISH-BORN, AND NUMBER OF WINDOWED ROOMS IN EACH.
Under 1
Year.
1
-4.
5
-9.
in
14.
id
19.
20-
■24.
cu
m
0)
'a
CO
Is
M
Is
"Is
Is
a
<D
Is
Is
a>
"ce
+3
i
o
i
0
1
0
C— 1
0
S
0
<i
S
0
1 ^
1
...
2
1
3
1
1
2
16
14
30
21
31
52
1
1
...
1
1
1
3
4
3
16
19
2
2
14
14
31
3
34
2
3
5
11
13
24
22
11
33
7
4
11
4
4
1
14
15
16
11
27
34
32
66
26
27
53
16
16
32
10
25
35
18
37
55
3
3
36
42
78
27
47
74
10
20
30
7
14
21
5
35
40
3
1
4
2
4
6
4
5
9
1
4
5
5
5
7
1
8
3
3
5
5
"1
1
1
1
8
8
2
2
1
1
5
5
3
"3
6
6
7
7
1
1
3
1
4
5
1
6
10
10
1
1
17
1
18
22
2
24
1
1
2
7
"7
142
142
21
21
2
2
1
1
16
8
24
31
19
50
36
23
59
50
23
73
48
109
157
3
3
"7
14
21
7
6
■'13
8
9
"17
7
12
19
5
9
14
1
1
4
1
5
25
25
3
1
4
1
1
12
14
26
35
65
100
1
1
1
1
31
31
29
29
1
1
4
4
18
18
34
34
1
1
6
6
14
14
-7
27
1
1
3
3
2
2
2
2
■1
2
4
4
6
6
1
1
11
11
189
189
0
1
3
18
18
152
152
25
25
3
12
15
12
17
29
9
9
18
5
15
20
17
17
34
42
94
136
8
3
11
70
17
87
6
5
11
1
1
9
•1
11
23
23
1
1
17
9
26
47
48
95
38
46
84
19
11
30
14
2
16
1
1
1
3
4
2
6
8
4
4
11
11
5
5
4
4
18
18
16
16
3
3
10
10
16
16
1
1
1
1
1
1
7
7
19
1
20
...
3
3
6
6
24
1
25
37
37
1
1
22
19
41
27
42
69
1
1
2
1
1
3
3
15
15
12
12
7
3
10
2
2
1
1
7
2
9
26
26
1
1
4
1
5
20
20
22
22
2
2
11
11
1
1
12
7
19
16
10
26
25
11
36
18
51
69
32
89
121
7
6
13
3
5
8
6
3
9
12
11
23
1
1
1
1
5
5
14
14
4
4
19
1
20
1
1
3
3
2 2
22
1
3
4
7
2
9
8
4
12
10
9
19
5
8
13
2
2
4
7
7
25
25
3
1
4
28
28
1
6
4
10
10
9
19
0
/
12
si
1 f\
IV
18
11
23
34
21
18
39
35
32
67
8
16
24
2
2
4
4
31
31
93
93
1
1
2
1
3
3
7
10
19
32
51
13
13
150
150
27
27
36
36
22
22
28
28
56
15
16
7
7
4
4
1
1
2
1
3
5
5
1
2
3
68
69
137
78
83
161
35
40
75
24
38
62
23
110
133
7
5
12
33
25
58
20
23
43
14
10
24
198
3
201
168
15
183
7
15
22
23
19
42
18
17
35
10
6
16
15
13
28
18
35
53
52
56
108
287
274
561
411
420
831
654
600
1,254
785
483
1,268
1,013
934
1,947
46
TABLE III.-
25
34.
SANITARY DISTRICTS.
Name of Institution.
oi
Q
Females.
c
(
Hotel,
40
65
BLYTHSWOOD,
Hotel,
Y.M.C.A., 100 Bothwell Street,
10
14:
24
■ \
35
O
41
[
Sick Children's Hospital,
1
18
19
City Poorhouse, ...
58
O 1
145
1
EXCHANGE,
. J
Fever Hospital, Kennedy Street,
4
Q^?
•DO
40
I
The Night Asylum for the Houseless, ...
44
1 ft
io
62
Old Man's Home and Asylum for Old W^omen,
Q
9
Lodging-House, 173 High Street,
29
29
3
HIGH STREET AND CLOSES WEST, .
Do., 195-207 do.,
Do., 34 Stirling Street,
Central Police Office, ... ... ... _ ...
Slatefield Industrial School, ... ... • . . .
49
27
27
T
1
27
49
49
1
5
BELLGROVE AND DENNISTOUN,
\
Glasgow Royal Infirmary,
"76
i/O
171
■ 1
St. Joseph's Home, ... ... ... ...
4
4
I
Old Barracks, Gallowgate,
9
1 1
21
f
Drygate Model Lodging-House,
105
I
106
H.M. Prison, Duke Street,
30
153
Lodging-House, 48 Duke Street.
4b
46
6
HIGH STREET AND CLOSES EAST, .
Do., 39 Watson Street,
79
79
Do., 21 do.,
112
i
113
Dn 14 16 Hn
•^6
OR
r
Home for Friendless Females, 8 Watson Street,
Catholic Orphanage for Boys, ...
2
oo
Ik)
20
2
7
GREENHEAD AND LONDON ROAD, ..
.
Do. do. Girls. ...
0
5
1
Belvidere Fever Hospital,
84
175
259
10
f
City Orphan Home,
2
■i
6
ST. ANDREW SQUARE,
i
■ 1
Lodging-House, 4-5-49 Greendyke Street,
Family Home. St. Andrew Street,
Lodging-House (Female), 20 Moncur Street, . . .
56
23
4
30
56
27
30
11
CALTON,
J
Do.. 66 Moncur Street.
43
43
• i
Do., 179 Great Hamilton Street, ...
122
122
1
Do., 58-52 Clyde Street,
71
I
72
LI
ST. ENOCH SQUARE,
James Watt Street Home, 22 James Watt St.,
100
1
101
• \
v
Hotel,
90
u
20
49
13
BROWNFIELD,
Model Lodging-House, 28 M Alpine Street,
70
1
1
71
14
BRIDGEGATE AND WYNDS, ... ' .
Lodging-House, 6-14 Miller's Place,
10
/
17
15
WOODSIDE, ,.
Lodging-House, 5 1 North W^oodside Road,
78
78
16
COWCADDENS,
' /
Lodging-House, 1 Burns Street.
QQ
w
99
■ \
Do., 16 Garscube Lane,
45
45
17
Western Infirmary,
53
147
200
KELVINHAUGH AND SANDYFORD,
j
Eye do..
Q
t?
8
17
18
■ 1
Clydesdale Model Lodging-House, Cheapside St.,
oyj
1
31
ANDERSTON,
Hydepark Model Ijodging-House,
71
71
20
LAURIESTON,
Kingston Model Lodging-House,
74
74
21
HUTCHESON SQUARE
Sanitary Reception-House,
5
8
13
22
GORBALS,
' f
Carlton Model Lodging-House,...
98
98
I
Portugal Street Model Lodging-House,
107
1
108
25
LANGSIDE AND MOUNT FLORIDA, .
■{
Victoria Infirmary,
13
45
58
Deaf and Dumb Institution,
2
4
6
29
KELVINSIDE,
■{
Training College, ...
Royal Asylum, Gartnavel,
Girls' Industrial School, ...
Magdalene Institution, ...
22
22
45
45
90
4
20
4
20
30
MARYHILL, ...
Eastpark Home,...
1
7
8
. -
Maryhill Lodging-House,
24
1
25
Ruchill Fever Hospital, ...
27
110
137
Government Barracks, ...
84
46
130
31
POSSILPARK AND BARNHILL,
Barnhill Poorhouse,
54
83
137
Total within Municipal
Boundary,
2,311
1,319
3,630
47
ntinued.
0
45 54.
ftS 64
65 AND Upwards.
Not
Known.
35 44.
P5
H .
c S
Males.
Is
s
CD
0)
B
rv.
0
H
W
0)
w
s
0
H
w
0)
s
"3
m
"cS
<a
Is
+^
0
EH
h-t
"A
'A
«
w
27
6
33
12
1
13
1
-t
4
4
1
5
21
379
7
6
13
1
6
7
5
5
1
3
18
91
21
2
2
23
2
12
9
1
14
1
4
4
2
2
2
7
208
93
104
1
70
6
174
7
131
65
2
196
2
183
1
139
2
322
3
267
295
562
426
10
256
122
43
19
62
28
18
46
20
17
37
7
3
10
03
57
2
2
2
2
13
2
15
113
52
165
18
77
53
1
54
50
50
20
20
7
7
05
16
5
33
33
23
23
20
20
19
19
18
"50
50
49
1
50
18
18
7
7
36
33
15
7
22
9
11
4
1
24
83
1
1
i
1
9
32
56
39
95
36
26
62
20
15
35
5
6
11
93
206
5
5
8
8
17
20
37
87
97
184
190
48
6
7
13
5
5
10
2
1
.3
1
1
0
60
103
103
74
1
75
42
42
12
12
149
16
13
71
84
8
28
36
2
11
13
1
1
2
65
643
39
1
40
29
29
25
25
5
5
37
15
85
85
71
71
39
39
21
21
00
8
165
165
109
109
59
59
26
26
134
8
29
29
28
28
18
18
6
6
33
4
20
20
1
1
19
2
20
3
9
9
2
1
2
1
7
14
27
21
3
3
2
2
2
2
1
1
14
29
46
69
115
13
32
45
2
13
15
1
2
3
57
327
1
3
4
1
1
1
1
2
1
1
1
52
87
1
88
63
63
34
34
10
10
122
12
45
1
46
33
1
34
11
2
13
3
3
21
176
54
54
59
59
54
54
37
37
43
14
38
38
30
30
29
29
15
15
42
11
n9
219
188
188
98
98
44
44
155
11
[12
1
113
86
86
48
48
20
20
120
12
93
93
65
65
39
39
10
10
103
16
11
6
17
17
17
2
2
1
1
36
282
68
68
89
89
46
46
21
21
H3
16
15
8
23
14
"'7
21
1 7
J. 1
8
25
5
1
6
39
12
95
1
96
81
81
51
51
14
14
60
11
.08
108
83
1
84
41
41
21
21
74
10
72
70
70
42
42
13
13
64
9
49
33
82
30
19
49
12
12
24
5
3
8
80
381
6
2
8
8
5
13
9
4
13
5
2
7
13
65
32
32
28
28
1 0
1 8
4
4
71
7
.04
104
91
1
92
42
42
16
16
129
17
^82
82
77
77
37
37
15
15
70
12
7
"'7
14
4
3
7
3
3
6
1
1
10
19
i.02
Q9
Q9
59
59
20
20
104
12
i.21
1
122
104
1
105
40
40
22
22
118
24
8
19
3
6
27
3
6
15
11
3
26
3
5
1
1
1
6
1
1
5
2
7
24
2
32
206
68
94
57
55
3
21
2
112
3
21
2
38
85
2
2
123
2
2
41
56
1
1
1
97
1
1
1
22
"47
"69
16
3
7
3
347
70
23
46
30
30
15
1
16
"17
17
5
5 1 ...
33
10
: 9
32
41
4
7
11
6
6
53
415
29
13
42
4
3
7
1
1
55
284
75
77
152
119
82
201
141
128
269
206
270
476
346
85
:i39
718
3,257
2,115
540
2,655
1 1,381
533
1
1,914
'1,076
845
1,921
1
1
3,708
5,695
48
02
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Percentage
of
Irish-Born
(Whole
Population).
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54
TABLE IX.— CENSUS, 1901— GLASGOW: AGE AND SEX OF THE POPULATION IN MUNICIPAL WARDS
MUNICIPAL WARDS.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.3.
14.
15.
16.
17.
18.
19.
21.
22.
23.
24.
25.
DALMARNOCK, -
CALTON, -
MILE-END,
WHITEVALE, -
DENNISTOUN, -
SPEINGBURN, -
COWLAIRS,
TOWNHEAD,
BLACKFRIARS, -
EXCHANGE,
BLYTHSWOOD, -
BEOOMIELAW, -
ANDERSTON, -
SANDYFORD, -
PARK,
COWCADDENS, -
WOODSIDE,
HUTCHESONTOWN,
GORBALS,
KINGSTON,
GOVANHILL,
LANGSIDE,
POLLOKSHIELDS,
KELVINSIDE, -
MARYHILL,
rWithout Institutions,
\Institutions, -
J Without Institutions,
\lnstitutions, -
J Without Institutions.
\Institutions, -
[Without Institutions,
\lnstitutions, -
(Without Institutions,
\lnstitutions,
rWithout Institutions,
\ Institutions. -
(Without Insts. & Shipping,
Institutions, -
Shipping,
/Without Institutions,
\lnsfcitutions, -
(Without Insts. & Shipping,
Institutions,
Shipping, -
/Without Institutions,
\Institutions, -
{Without Insts. & Shipping,
Institutions, -
Shipping,
{Without Insts. 6i Shipping,
Institutions, -
Shipping.
/Without Institutions,
\lnstitutions, -
/Without Institutions,
(Institutions, -
/Without Institutions,
\Institutions, - - -
/AVithout Institutions,
\Institutions, -
/Without Institutions,
\lnstitutions. -
{Without Insts. & Shipping,
Institutions, -
Shipping,
/Without Institutions,
/Institutions, -
/Without Institutions,
/Institutions, -
(Without Insts. & Shipping,
Institutions, -
Shipping, - - -
All Ages.
Under 1 Year.
Males.
Total without Institutions and Shipping,
Total Institutions, - - - _
Total Shipping, - - - - -
Total within Municipal Bouxdary,
2.5,623
234
17,020
1,880
20,814
■ 205
17,606
1,423
14,552
845
19,478
790
13,565
20,512
957
24
15,311
662
1.165
274
5
2,138
150
5,022
818
87
15,087
480
760
12,886
65
10,670
297
19,815
1,006
22,003
16,285
52
17,838
828
17,123
311
339
15,587
11,267-
153
6,267
.5.471
227
16,574
968
16
Females. Total. I Males. Females. Total,
359;679
12,625
1,231
373,535
27,164
455
18,448
433
21,296
213
18,099
163
15,930
681
18,266
882
13,032
19,980
1,008
16^095
294
1.161
177
2.471
61
4,611
84
14,847
3
8
13.563
46
14,233
452
20,057
8
23,444
17,118
50
17,912
4
17.263
15,977
14,145
207
9,050
10.140
489
17,143
1,012
381,445
6,722
10
388,177
52,787
689
3.5,468
2,313
42,110
418
35.705
1,586
30,482
1,526
•37,744
1,672
26,597
40.492
1,965
24
31,406
956
2,326
451
5
4,609
211
9,633
902
87
29,934
483
768
26.449
111
24,903
749
39,872
1,014
45,447
33,403
102
35,750
832
34,386
311
341
31,564
25.412
360
15,317
15,611
716
33,717
1,980
16
19,347
1,241
761,712
928
3
511
1
723
523
2
434
4
696
7
415
612
19
424
19
3
23
105
448
287
138
3
503
685
571
1
427
437
498
235
1
73
86
.570
741,124 10,371
52
10,423
872
12
483
1
714
502
420
1
657
15
419
595
11
434
2
14
1
"20
109
447
273
141
3
.551
672
520
3
403
426
466
282
82
91
'594
7
10,187
56
10,243
f
55-
)ISTINGUISHI]SrG THE INMATES OF INSTITUTIONS AND SHIPPING ; ALSO NUMBER OF IRISH-BORN.
1 4.
5 9.
10 14.
15 19.
Males.
Females.
Total.
Males.
Females.
Total.
Males.
Females.
Total.
Males.
Females.
Total.
2,810
2,876
5,686
3,197
3,060
6,257
2,806
2 882
5 688
2 592
2,810
5,402
12
' 17
' 29
9
■9
18
5
15
' 20
17
17
' 34
1.655
1,721
3.376
1,878
1,928
3,806
1,736
1,890
3,626
1,746
1,831
3,577
18
14
32
49
55
104
53
54
107
133
41
174
2,433
2,387
4,820
2,650
2,627
5.277
2,284
2,259
4,543
2,080
2,076
4,156
1
1
11
18
29
189
152
341
2
26
28
1,780
1,798
3,578
2,050
1,970
4,020
1,815
1,858
3,673
1,721
1,816
3,537
8
15
23
17
8
25
161
11
172
92
16
108
1,425
1,451
2,876
1,645
1,572
3,217
1,365
1,477
2,842
1,390
1,573
2,963
16
8
24
31
19
50
37
24
61
66
38
104
2,136
2,116
4,252
2,287
2,204
4,491
1,910
2,064
3,974
1,877
1,777
3,654
23
19
42
18
17
35
10
6
16
15
13
28
1,375
1,567
2,942
1,647
1,636
3,283
1,512
1,505
3.017
1,408
1,337
2,745
1,913
1,832
3,745
2,215
2,079
4,294
1,970
2.028
3,998
2,088
2,007
4,095
70
74
144
53
74
127
26
36
62
17
39
56
1
1,464
1,534
2,998
1,720
1,681
3,401
1,527
1,550
3,077
1
1,583
1,639
3,222
1
1
1
6
7
4
4
8
35
11
46
66
90
156
108
107
215
88
96
184
135
146
281
2
4
6
4
5
9
2
4
6
27
19
46
90
106
196
114
134
248
155
162
317
245
255
500
1
1
2
1
3
15
3
18
390
380
770
459
446
905
432
449
881
540
472
1,012
6
0
8
8
1
9
43
15
58
1
1
9
9
1,417
1,500
2,917
1.595
1,615
3,210
1.529
1,483
3,012
1,544
1,449
2,993
1
1
1
1
9
9
1
1
59
59
1,002
968
1,970
1,217
1,144
2,361
1,197
3
1,196
2,393
1,391
1,412
2,803
9
7
6
13
5
8
6
3
588
598
1,186
730
851
1,581
971
969
1,940
1,211
1,509
2,720
23
20
43
38
21
59
32
15
47
18
55
73
1,795
1,951
3,746
2,130
2,199-
4,329
2,073
1,974
4,047
2,043
2,000
4,043
2
2
1
1
4
2
6
29
2
31
2,312
2 242
4,554
2,521
2,557
5,078
2,387
2,319
4.706
2,206
2,262
4,468
1,906
1^908
3,814
2,084
2,048
4,132
1,756
1,789
.3,545
1,641
1,681
3,322
7
2
9
8
4
12
10
9
19
5
8
13
1,4:1 1
l.OO /
1,745
1,781
3,526
1,694
1,761
3,455
1,906
1,910
3,816
10
1
11
1,'493
1,492
2,985
1,773
1,780
.3,553
1,685
1,737
3,422
1,891
3
1,789
3,680
1
1
3
36
36
1,615
1.574
3.189
1.844
1,741
3,585
1,627
1,578
3.205
1,576
1,561
3,137
966
957
1,923
1,215
1,189
2,404
1,134
1,151
2,285
1,090
1,576
2,666
6
1 0
O 1
-J /
Do
40
•39
/9
16
25
42
379
356
735
554
539
1,093
622
644
1,266
731
1,185
1.916
325
290
615
465
468
933
481
534
1,015
608
1,022
1,630
1
1
2
5
7
3
38
41
1.875
1,896
3,771
1.902
1,889
3,791
1,637
1.662
3,299
1,537
1,558
3,095
101
94
195
126
147
273
64
'217
281
224
'll2
336
34,621
34,977
69,598
39,745
39,245
78,990
36,393
37,017
73,410
36,780
38,653
75,433
287
274
561
411
420
831
654
600
1,254
785
483
1,268
2
2
^ 105
105
34,908
35,251
70,159
40,156
39,665
79,821
37,049
37,617
74,666
37,670
39,136
76,806
56
TABLE IX.
MUNICIPAL WARDS.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
20.
21.
22.
23.
24.
25.
DALMARNOCK,
CALTON, -
MILE-END,
WHITEVALE,
DENNISTOUN,
SPRINGBURN,
COWLAIRS,
TOWNHEAD,
BLACKFRIARS,
EXCHANGE,
BLYTHSWOOD,
BROOMIELAW,
ANDERSTON,
14.
SANDYFORD, -
15.
PARK,
16.
COWCADDENS, -
17.
WOODSIDE,
18.
HUTCHESONTOWN,
19.
GORBALS, -
KINGSTON,
GOVANHILL, -
LANGSIDE,
POLLOKSHIELDS,
KELVINSIDE, -
MARYHILL,
rWithout Institutions,
\Institutions, -
/"Without Institutions,
\Institutions, -
rWithout Institutions,
\Institutions,
/Without Institutions,
\ Institutions, - - -
(Without Institutions,
\ Institutions. - - -
(Without Institutions,
\Institutions, -
{Without Insts, & Shipping,
Institutions, -
Shipping, - _ -
/Without Insts. & Shipping,
\lnstitutions, -
(Without Institutions,
Institutions, -
Shipping,
/ Without Institutions, •
I Institutions, -
{Without Insts. & Shipping,
Institutions, -
Shipping,
{Without Insts. & Shipping,
Institutions, -
Shipping, - - -
/Without Institutions,
^Institutions, - - -
/Without Institutions,
\ Institutions, -
/Without Institutions,
\lnstitutions, -
/Without Institutions,
\Institutions. -
/Without Institutions,
\ Institutions, -
(Without Insts. & Shipping,
Institutions, -
Shipping,
/Without Institutions,
(•Institaitions, -
/Without Institutions,
\Institutions, - - -
rWithout Insts. & Shipping,
J Institutions. -
(shipping, - - - -
20-
-24.
Males.
Females.
Total without Institutions and Shipping,
Total Institutions, . - . -
Total Shipping, . . - - -
Total within Municipal Boundary,
2,497
42
1,739
94
2,062
1.935
100
1,460
108
2,162
18
1,516
2,404
23
6
1,749
47
151
34
1
354
34
646
73
10
1,718
33
156
1,671
12
1,572
33
2,365
59
2,183
1,558
2
2,288
53
1,992
1,614
1,033
11
683
612
19
1,729
196
39,693
1,013
249
40.955
2,699
94
1,873
13
1,991
1,793
15
1,780
174
1,831
38
1,257
2,152
72
1,660
17
148
43
364
19
504
31
1,472
1
1
1,574
11
1,946
103
2,086
2,391
1,727
2
2,024
1,818
1.660
1,552
25
1,430
1,827
125
1,870
151
41,429
934
1
42,364
Total.
5,196
136
3.612
107
4,053
3,728
115
3,240
282
3,993
56
2,773
4,556
95
6
3,409
64
299
77
1
718
53
1,150
104
10
3,190
34
157
.3,245
23
3,518
136
4.451
59
4,574
3,285
4
4,312
53
3,810
22
68
3,274
2.585
36
2.113
2,439
144
3,599
.347
8
81,122
1,947
250
25-
-34.
Males.
Females.
4,273
84
2,787
317
3,372
2.
2,987
272
2,783
211
3,599
54
2,188
3,627
62
7
2.590
115
225
73
439
45
949
210
29
2,650
101
290
2,268
9
1,941
54
3,450
222
3,863
2,738
5
3,311
205
2,942
74
121
2,931
2.012
15
913
905
45
3,261
136
6
63,004
2,311
453
83,319 65,768
4,345
175
2,840
39
3,353
5
2,988
34
3,036
219
2,981
87
1,923
3.349
123
2,609
65
196
38
528
20
721
, 27
2,530
1
5
2,355
8
2,870
165
3,233
4,260
2,847
8
2,979
1
2,843
2
2,946
2.820
49
1,664
2,497
67
3.280
188
65,993
1,319
7
67,319
■ontinued,
35 44.
45 54.
55 64.
1 65 AND Upwards.
Not Known.
Born in
1
Ikeland.
Total.
Males.
Iremales.
Total.
Males.
Females.
Total.
Males.
Females
Total.
1
F.
Tl.
3 265
6 247
1 944
4 065
1 081
1 358
•7 43q
510
876
1 386
1
1 ^
3
4 989
i 4-fi
69
115
13
32
45
2
13
1 5
X 0
\
2
3
57
2 347
4 525
1 487
1.632
3 119
875
1 1 74
J. ) J. 1 t:
2 049
427
727
1 154
1 1
2
3
(J ) 1 (J
502
60
562
400
61
461
221
57
■^78
92
38
1 30
2,416
2 504
4 920
1 592
1 636
1 8-'>4
436
685
1 1 91
4.
9
R
3 495
3
3
1
4
5
2
2
2
2
98
2 168
2 231
4.399
1 351
1 472
2 823
787
99-'
U u -1
1 779
461
641
U T: X
1 109
X J X V/—/
28
38
6fi
9 Qf!8
325
28
353
243
24
1 43
1 0
J. \J
1 53
59
2
fil
1
X
1
X
— (OO
1 834
2,001
3,835
1 214
1,-1 1-±
1 •''74
1,-; / ■±
2 488
666
81 9
1 485
335
526
861
OU X
\
1
L
2
X J -J "J «7
172
110
282
118
55
173
64
'>6
90
18
7
95
307
2 306
2 157
4 463
1 478
1 331
2 809
739
758
1 4Q7
988
U 1 0
5 RfiS
(J, 000
75
82
'l57
119
90
209
158
1 48
306
293
367
U U vy
53fi
1 554
1 475
3 029
1 1 3
1 026
2 149
1 1 51
X J X X
935
398
9 fiOl
2 433
2 389
4 822
1 836
1 771
1 J 1 1 J.
3 607
1 00-^
_j J X X 0
41 9
U U
1 07J-
1 07
105
76
181
131
67
198
184
141
325
267
295
562
43fi
4
4
4
4
1
\
\
a
\j
1 947
2,026
3 973
1 288
1,419
2,707
678
957
1 635
341
584
925
9
9
133
51
184
122
35
157
72
31
1 03
132
79
90i
1 98
X t/O
142
143
285
123
108
231
72
66
1 38
X 'JO
36
4-7
00
1 98
54
25
79
45
18
63
22
1 7
3C)
8
0
1 1
1 i
qq
2
2
2
2
1
J.
258
333
591
222
259
481
153
350
85
1 98
93fi
28
8
36
13
8
21
9
9
4
X
(J
90
-)\J
628
575
1.203
485
455
940
'>87
317
604
99
1 81
1 0 X
980
_j 0 V7
2
2
A
4:
1 ^Of>
J- , .J w u
188
6
194
166
1
167
89
89
35
1
X
3ri
907
18
18
15
15
5
5
a
u
1,885
1,805
3,690
1 281
1,259
2,540
717
788
1.505
303
499
T: t/
809
^ q7i
0,011
136
136
119
\
120
fiO
fiO
\j\J
90
— V7
900
152
1
153
65
66
29
29
A
u
u
2
2
fi5
uo
1 537
1,670
3,207
1,181
1 411
•~> 59-^
.1,00-,
7fifi
t \J\J
O'J i
1 793
36Q
(i09
\J\J -1
Q7l
1
i
1
1
9 1 98
6
2
8
8
5
13
Q
tj
A
1 3
X fJ
2
1
X 0
1,383
2,061
3,444
1,045
1,464
2.509
676
1 nfi4
1 740
75Q
1 1 71
1
i
1
i
; 49
35
84
30
20
50
12
12
24
3
87
2,425
2,407
4,832
1,699
1 818
3 517
919
1 1 fi4
2 083
41 9
J. J WO_j
1
i
A
4:
r)
1 9SR
275
1
'276
234
\
235
1 34
1 34
4- Si
^0
1 qs
' 2,754
2,856
5.610
1,759
1,931
3,690
929
1 1 90
2 119
403
1 1 '^1
1 , i U 'J
1
i
2
■J
.>
9 fiqi
1^928
2!039
3,967
l'206
1,'337
2^543
643
735
1^378
254
487
741
9 59
j,.J^9
7
7
14
4
3
7
3
3
6
1
1
1 0
2,143
2,131
4,274
1,502
1,628
3,130
940
1,213
2,153
471
695
1,166
q 99fi
223
1
224
196
1
197
99
99
42
42
222
2,039
2,085
4,124
1,542
1,590
3,132
926
1,101
2,027
398
600
998
5
9
7
2,820
82
82
77
77
37
37
15
15
70
56
56
41
41
15
15
2
2
42
1,805
1,914
.3,719
1,189
1.289
2,478
622
769
1,391
265
479
744
1
1
1,836
1,562
1,934
3,496
1,039
1,188
2,227
580
859
1,439
401
637
1,038
630
8
22
30
15
11
26
5
2
7
5
2
7
26
782
1,193
1,975
736
896
1,632
498
586
1,084
296
475
771
356
728
1,401
2,129
606
928
1,534
406
622
1,028
249
459
708
1
1
355
57
61
118
38
88
126
'41
57
98
22
47
69
48
2,018
2,068
4,086
1,185
1,245
2,430
602
682
1,284
258
399
657
4,374
68
71
139
23
15
38
17
10
27
5
5
154
1
1
1
1
4
13,835
47,010
90,845
30,113
32,488
62,601
16,918
21,105
38,023
8,159
13,283
21,442
47
58
105
62,274
2,539
718
3,257
2,115
540
2,655
1,381
533
1,914
1,076
845
1,921
1
1
3,708
231
1
232
128
1
129
52
52
9
9
2
2
124
16,605
47,729
94,334
32,356
33,029
65,385
18,351
21,638
39,989
9,244
14,128
23,372
50
58
108
66,106
58
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60
TABLE XI.— CENSUS, 1901— GLASGOW : NUMBER OF INMATES, WINDOWED ROOMS, AND
IRISH-BORN IN INSTITUTIONS IN EACH MUNICIPAL WARD.
Number of Inmates.
:land.
Rooms.
MUNICIPAL WARDS.
Name of Institution.
o5
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<u
s
0)
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H
a
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pq
c
1
DALMARNOCK, ...
Belvidere Hospitals,
234
455
689
57
327
Lodging-House, 20 Moncur Street,
4
263
267
43
14
Do., 66 do.,
193
193
42
11
Do., 179 Great Hamilton Street, ...
700
700
155
11
2
C ALTON, ...
Do., 52-58 Clyde Street,
363
6
369
120
12
City Orphan Home,
88
35
123
1
52
Lodging-House, 45-49 Greendyke Street,
282
4
286
122
12
MILE-END, 1
. Family Home, St. Andrew Street,
250
125
375
21
176
3
Catholic Orphanage for Boys,
Do. do. Girls,
205
5
208
210
208
14
14
21
29
Slatefield Industrial School,
175
2
177
9
32
Old Barracks, Gallowgate,
57
75
132
2
60
Lodging-House, 48 Duke Street,
206
1
207
37
15
4
WHITEVALE,
Do., 39 Watson Street,
352
352
66
8
Do.. 21 do.,
519
1
520
134
s
Do., 14-16 do.,
111
111
33
4
Mission Hall for Friendless and Fallen Females,
3
84
87
7
27
{
Glasgow Royal Infirmary,
375
363
738
93
206
5
DENNISTOUN, ... i
Drygate Model Lodging-House, ...
365
4
369
149
16
i
H.M. Prison,
105
314
419
65
643
ClPPT'MTJ'RTTP'M J
St. Joseph's Home,
Barnhill Poorhouse,
104
686
137
745
241
1,431
190
346
48
85
8
TOWNHEAD, ... |
City Poorhouse, ...
Fever Hospital, Parliamentary Road, ...
Old Man's Home and Asylum for Old Women,
863
94
804
204
1.667
298
426
10
256
122
r
126
75
201
18
77
Lodging-House, 173 High Street.
168
2
170
65
5
Q
Do., 195-207 do., '
Do., 34 Stirling Street,
1
192
145
3
146
195
16
. 36
18
33
Do., 6-14 Miller's Place, ... ...
80
34
114
39
12
1
Central Police Office,
95
35
130
24
83
1 n
iU
JbAL>±lAJNlir£i, ... y
The Night Asylum for the Houseless, ...
164
90
254
63
57
Hotel,
110
87
197
36
282
i i
JSJjX Ixlb WUvL', ... y
Hotel,
Y.M.C.A., 100 Bothwell Street,
29
121
48
13
77
1.34
18
2
91
208
{
Lodging-House, 28 M'Alpine Street,
314
2
316
83
16
12
EROOMIELAW, ...
James Watt Street Home,
377
2
379
103
16
1
Hotel,
127
80
207
21
379
13
ANDEKSTON, ... |
Hydepark Lodging-House,
347
2
349
129
17
Clydesdale do.,
133
1
134
71
7
14
SANDYFORD,
Eye Infirmary,
65
46
111
13
65
15
PARK, 1
Western Infirmary, ... ... ... ...
Sick Children's Hospital,
253
44
382
70
635
114
80
7
S81
93
Lodging-House, 51 North Woodside Road,
352
6
35 y
60
11
16
COWCADDENS, ... |
Do., 1 Burns Street,...
399
2
401
74
10
Do., 16 Garscube Lane,
255
255
64
9
18
HUTCHESONTOWN,
Sanitary Reception-House,
52
' 50
102
10
19
19
GORBALS, 1
Carlton House,
Lodging-House, Portugal Street,
403
425
4
403
429
104
118
12
24
20
KINGSTON,
Lodging-House, Centre Street, ...
311
311
70
12
22
LANGSIDE,. 1
Victoria Infirmary, ... ... ... . . . 1
87
131
218
24
206
"T"\ P T T-\ 1 1 i *J_ J_- 1
Deal and Dumb institution, ... !
66
76
142
2
68
24
KELVINSIDE, ... |
Training College, ... ... ... . . . |
Royal Asylum, Gartnavel, ... ... ... 1
Girls' Industrial School, ... ... ... ... |
227
160
329
160
556
32
16
94
347
200
200
3
70
Magdalene Institution, ...
102
102
7
23
25
MARYHILL, ... ]
Eastpark Home, ...
Maryhill Lodging-House,
44
98
65
4
109
102
3
33
46
10
Ruchill Fever Hospital, ...
269
497
766
53
415
Government Barracks, ...
557
144
.701
55
284
Total,
12,625
6,722
19,347
3,708 1
5,695
61
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CO CI OO 1^ CI
05 CO CI CO
00 CD CO 1— (
CO -* 1— I ^
-H CO CO CI CI
CI t- CI CO
O -tH CT t~ 00
CI r— I 1 — ^ 1 — I
1— I 1^ CI 05 r— I
t— 1— I CO O
1— I T— I CI 1—1
o o o o o
in cT CI in Cl
CO Cl m 00 m
CO O CD CO C73
CO CO CO cq
o >— I CO in o
CO cj ^ cq Cl
CO Cl o i>- CO
Cl Cl Cl Cl I— I
CO -* 05 <»
1— I in -H
Cl ^ 05 -4l Cl
C75 t~ -rt< in CO
Cl O p t-
CO do CO
Cl 1—1 CO 1—1 r— I
1— I in CO o Cl
o CO CO in CD
m
P
P3
<
<
Ph
13
P S S ^ ft
|l4 O
2 M
S g
<j o
n
o
h
fx -
«2
o
Eh
s ^
S S
K !z;
Dos
MOM
i4
HH M
tu ft
» w
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f W S H
02 d
1— icico^in coj:^cx)050
Cl CO in
CO Xr~ 00 c:5 o
1 — I 1 — I 1 — ^ 1 — I Cl
I— I Cl CO in
Cl Cl Cl Cl Cl
63
TABLE XIV.— CENSUS, 1901— GLASGOW : AVERAGE NUMBER OF INMATES PER HOUSE OF
EACH SIZE AND OF ALL SIZES, ALSO PERCENTAGE > OF EMPTY HOUSES IN
MUNICIPAL WARDS.
MUNICIPAL WARDS.
1
Apart-
ment.
2
Apart-
ments.
3
Apart-
ments.
4
Apart-
ments.
5
Apart-
ments
and
Upwards.
All
Sizes.
Per-
centage
of
Empty
Houses.
1
DALMARNOOK, -
3-218
5-266
5-941
5-765
j
7-298
4-599
4-5
1
2
CALTON,
3-019
1-962
5-746
6-314
7-754
4-644
5-4
2
3
MILE-END, -
3-287
5-232
6-200
6-227
7-432
4-628
4-4
3
■4
WHITEVALE,
3-305
4-935
5-643
5-902
9-240
4-773
2-5
4
5
DENNISTOUN,
2-997
4-346
4-981
5-332
5-859
4-629
3-7
5
6
SPRINGBUEN,
3-459
5-216
6-206
5-811
5-885
4-841
6-3
6
7
COWLAIRS, -
3-329
5-210
6-015
6-267
6-100
4-964
4-3
7
8
TOWNHEAD,
2-981
4-881
5-733
6-135
7-292
4-795
4-9
8
9
BLACKFRIARS, -
3-164
4-986
5-871
6-595
9-311
4-833
4-8
9
10
EXCHANGE, -
2-701
4-571
6-120
5-600
9-130
5-499
6-2
10
11
BLYTHSWOOD, -
2-611
3-971
4-994
5-000
6-886
5-448
3-1
11
12
BROOMIELAW, -
2-899
4-916
5-788
6-780
12-127
5-310
3-7
12
13
ANDERSTON,
3-036
4-882
5-733
5-752
6-375
4-785
2-6
13
14
SANDYFORD,
3-163
4-754
5-241
5-596
5-620
4-848
3-3
14
JrAKK, - - - -
2-419
4-237
4-733
4-707
5-796
4-979
3-1
15
16
COWCADDENS, -
3-1 GS
5-005
5-638
6-237
7-100
4-760
5-4
16
17
WOODSIDE, -
3-051
4-714
5-389
5-491
5-807
4-641
4-0
17
18
HUTOHESONTOWN,
3-178
5-115
6-323
7-077
U 0\J\J
■J: 'JOO
-J 1
i o
19
GORBALS, -
2-954
4-768
5-495
6-101
6-785
4-934
3-8
19
20
KINGSTON, -
3-214
4-842
5-221
5-802
6-570
4-828
2-6
20
21
GOVANHILL,
3-382
4-517
5-281
5-073
5-942
4-624
3-4
21
22
LANGSIDE, -
2-622
4-135
4-083
4-613
5-580
4-634
7-1
22
23
POLLOKSHIELDS,
2-872
4-964
4-796
4-414
5-663
5-222
5-9
23
21
KELVINSIDE,
2 333
4-6.30
4-106
4-443
5-677
5-230
6-3
24
25
MARYHILL, -
3-329
4-792
5-314
4-702
5-374
4-714
8-3
25
CITY -
3 183
4-927
5-409
5-330
6-054
4-769
4-5 1
64
■73
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a;
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o
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bo
a
1-1
■73
o
Ph
o
CO
65
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M
o
Ph o
O H
Total.
1 o
CO
1,591
CI
lO
CO
2,203
1,033
IC
CO
t:
Total.
1 lO
1
in
CJ
OS
CO
c:s
CO
Cl
s
1,321
ARTMENTS.
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03
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/
CORPORATION OF GLASGOW.
ySMALLPOX, 1900-1902.
REPORT
BY
A. K. CHALMERS, M.D.,
MEDICAL OFFICER OF HEALTH.
GLASGOW :
PRINTED BY ROBERT ANDERSON, 142 WEST NILE STREET.
CONTENTS.
Page
I. General Outline of Outbreak —
Pre-epidemic Period, ... ... ... ... ... ... ... 9
Epidemic Period, ... ... ... ... ... ... ... ... 15
Recrudescence, ... ... ... ... ... ... ... ... 19
II. District Distribution —
Question of Hospital Influence, ... ... ... ... ... ... 23
Attack-rate in Districts presenting high general Death-rates, ... ... 30
III. Age Incidence —
Infantile Vaccination, ... ... ... ... ... „. ... 33
Mortality in Vaccinated, XJnvaccinated, and Doubtfully Vaccinated
Persons at several Age Periods, ... ... ... ... ... 36
The Age Incidence of Deaths in 1855-7, 1870-2, and 1900-1 compared, 37
IV. Re-vaccination —
In Relation to Attacks occurring within 14 days, ... ... ... 44
In Persons Re-vaccinated in former years, ... ... ... ... 45
The Re-vaccinated Portion of the Population, ... ... ... ... 46
Cost of Re-vaccination, ... ... ... ... ... .... ... 47
Appendices—
Tables of Meteorological Observations at Glasgow Observatory, ... 51-58
Daily Chart of Sickenings during Epidemic Period.
Do. DURING Recrudescence.
Maps Showing Distribution of Cases —
I. Registered in several fortnights ending 2nd June, 1900.
II. Sickening in several fortnights ending 30th June, 1900.
III. Do. in several fortnights ending 12th January, 1901.
IV. Registered in fortnight ending 2Gth January, 1901.
V. Do. in fortnight ending 9th March, 1901.
VI. Occurring during Recrudescence.
VII. Occurring in Eastern District during fortnight ending 22nd
February, 1902.
PROGRESS OF OUTBREAK.
General Outline.
The course of the Smallpox prevalence which began in April, 1900, has, up
till the date of reporting, presented, in a general way, three phases — a pre-epidemic
period ; one of epidemic severity within a comparatively limited area ; and, after an
interval of four months, a period of recrudescence.
The pre-epidemic period may be said to have lasted from the introduction of
the disease in April, 1900, until the following December. The epidemic attained
its maximum prevalence between January and March, 1901, after which the
number of attacks rapidly declined, and the last sickening in this phase of the
outbreak occurred on 29th June. It reappeared early in the following November,
and again displayed considerable vigour during the spring months of the present
year.
The separation of these periods is fairly definite, although, even in the early
weeks of the pre-epidemic stage, there was already evidence of widespread activity,
and in the middle of the epidemic period an interval of decreasing prevalence
occurred, which extended from 1st to ISth February, and separated the periods of
maximum sickening, which had occurred on 17th January and again on 1st
February, from a period of more sustained prevalence, beginning on 19th February
and ending on 2nd March.
The disease was introduced, under circumstances to be afterwards described,
into an overcrowded one-apartment house in District No. 11 (Calton), which
forms part of the eastern limit of the Central Sanitary District.* Ten or twelve
days elapsed before medical attendance was sought and the nature of the disease
recognised, with the result that in this and the next following fortnightly period
cases occurred in eight households in the same tenement, and in others elsewhere,
in persons, some of whom were only then found to have been resident in, or visitors
to, this tenement during the unrecognised period of the first patient's illness.
During the first fortnight of the outbreak (ending 21st April) all the cases
registered were among residents in the tenement in question, but already in the
second fortnight (ending 5th May) four almost simultaneous attacks occurred in
one household in the Eastern (Preston Street), which had no traceable con-
nection with the earlier cases, and in the third fortnight (ending 19th May) cases
were recorded in all the districts save the South-Suburban and North-Western.
In this last fortnight the cases numbered 21 in all, and 5 only of them could
be associated with known sources of infection. In the fortnight which ended
2nd June the new cases registered had a similar distribution, with the inclusion,
however, of two from the South-Suburban area. The North-Western remained free
from the disease till the closing fortnight of the year, when one case was registered.
* For statistical purposes the whole area of the City is divided iuto 34 Districts, which, for
purposes of administration, again are combined in 7 Groups, known also as Districts, and, for
convenience, referred to as East, Central, Northern, Southern, Western, South-Suburban, and
North-Western.
6
So far, a large proportion of the cases had occurred in the Central District,
in which the disease began, and until the close of the fortnight ending 2nd June,
of the 72 cases which had been registered, 33 were from the Central and 18
from the Eastern Districts of the City. In the following weeks a change in the dis-
tribution occurred, accompanied by evidence of increased activity in the propagation
of the disease. During the fortnight ending 16th June 40 new cases were registered,
27 of which were in the Eastern District ; and in the fortnight ending 30th June this
district contributed 34 of the 58 cases then recorded. This exaggerated incidence
in the Eastern District continued to characterise almost all the subsequent
fortnights until the disease disappeared in the following summer, and it again
became a feature in the development of the I'ecrudescence in the spring of 1902.
Although most of the other divisions in turn developed definite, and sometimes
repeated foci of infection, there occurred in none of them any prevalence at all
equal to that presented by the Eastern.
In the late summer and autumn of 1900 the disease abated, but late in
November an increase began, which finally reached its maximum intensity in the
week ending 19th January, 1901, when 255 new cases occurred.
In the following week the new cases fell to 93, but again in that ending 2nd
February 111 sickened. The next fortnight was characterised by diminishing
prevalence, 89 cases being recorded in the first and 62 in the second week ; and the
absence in this latter week of an increase, which might be assumed to have an
incubation period in definite time-relationship with those which had occurred in the
week ending 2nd February, appeared to indicate a moderation in the intensity of
the outbreak. In the three weeks which followed, however (23rd February,
2nd and 9th March), 100, 172, and 107 new sickenings occurred. In two periods,
therefore, each of three weeks' duration, and separated by an interval of two weeks
459 and 379 cases occurred; but whereas in the first period there was a markedly
diminished prevalence in the middle week, the prevalence during the last three
weeks was maintained throughout. To this circumstance we shall return.
In the period of recrudescence the distribution followed the main lines of the
pre-epidemic and epidemic prevalence.
It will be convenient here to tabulate the number of cases registered in the
several Sanitary Districts in the successive fortnights of each of the three periods
just referred to, and the accompanying maps should be referred to for information
regarding the general arrangement of the districts. The figures given in the
Tables here referred to include all admissions, and consequently contain some (27
in all) in which the subsequent development of symptoms warranted the exclusion
of smallpox, although the records of the individual fortnights had been closed
before the necessary corrections could be made. For this reason the numbers here
given are in excess of the revised figures to be subsequently dealt with : —
7
Table I.— Pre-epidemic Period, April — December, 1900. — Cases reported in the
SEVERAL FORTNGHTS.
Fortnight ending
Central.
East.
North.
South.
West.
S.-S.
N.-W.
Whole
City.
No. ill
Hospital.
21st April,
9
9
8
5th May, -
6
7
13
20
19th „ -
7
2
9
2
1
21
27
2nd June,
11
9
5
1
1
2
29
40
16th „
4
27
2
7
40
61
30th „
10
34
7
5
1
1
58
93
14th July,
2
9
1
1
13
68
28th „
5
18
o
25
49
1 1th August,
•)
18
1
1
1
23
55
25th
3
3
29
8th September,
2
11
2
15
30
22nd
1
6
3
11
23
6th October,
2
9
11
26
*20th
o
4
1
11
1
19
36
3rd November,
2
2
3
1
8
■ 25
17th
1
4
1
6
22
1st December, -
17
1
3
21
33
] 5th „
9
18
1
8
36
58
29th
8
18
3
5
1
1
1
36
75
Total,
83
216
26
41
23
7 1 1
397
* Nine of the cases in the Southern District here were employees in a wire factory in the district,
and 1 in the Central was a trade canvasser, whose occupation led hira to visit the works daily.
8
Table II. — Epidemic Period. — Cases reported in several Fortnights, 1901.
Fortnight ending
C6iitrcil.
East
North.
South,
West.
o. -o.
"NT W
±\ .- V V .
Whole
City.
No. in
Hospital.
12th January, -
6
15
1
1
23
63
26th
14
256
6
53
2
17
2
350
377
9th February, -
20
104
22
37
4
14
1
202
436
23rd „
20
67
11
17
2
7
3
127
368
9th March,
30
219
18
26
2
3
1
299
435
23rd „
16
109
12
16
4
3
1
161
373
6th April,
15
35
16
11
10
3
2
92
234
20th „
10
28
8
19
2
67
155
4th May,
3
10
6
7
1
1
28
102
18th „
2
12
3
1
18
55
1st June,
3
5
3
11
35
15th ,,
2
2
15
29th „
1
1
6
8
11
13th July,
1
1
3
Total, -
139
863
100
200
29
48
10
1,389
Table III. — Recrudescence, 1901-2. — Cases reported in the several Fortnights.
Fortnight ending
Central.
East.
North.
South.
West.
S.-S.
N.-W.
Total.
No. in
Hospital.
16 th November,
1
1
1
30th
5
5
6
14th December,
3
1
4
7
28th
7
1 1 th January, -
2
1
24
1
28
33
25th
4
3
13
2
1
23
55
8th February, -
3
4
13
3
23
50
22nd
12
102
14
7
3
2
7
147
169
8th March,
13
39
12
11
13
1
3
92
202
22nd „
6
32
14
25
1
3
4
85
104
5 th April,
5
15
2
11
2
1
36
105
19th „
3
6
2
1
2
1
15
71
3rd May,
3
4
2
1
10
37
Total,
48
205
103
65
24
9
15
469
9
Conditions influencing Early Spread of Infection.
The circumstances under which the first case occurred were exceptionally
fitted for the dissemination of infection, and, as we have seen, cases were occurring
before the end of April which were not traceably related to any known source.
This experience was frequently repeated, and independent foci of infection
were established before the summer of 1900 had well advanced. Associated cases
not infrequently occurred — grouped at one time in the neighbourhood of the
residence, at another among the fellow- employees of some one whose illness
had escaped recognition at the time of its occurrence. Mildness in type of
the original attack not infrequently explained these groupings, the first
illness being sometimes regarded as Chickenpox, or as a " bilious " affection, while
in others it had not come under observation at all until the secondary attacks
developed ; but evidence of communication between the groups was not always,
or indeed often, forthcoming, especially after the first weeks had passed.
It has already been indicated that the disease was unequally distributed
throughout the City, and it will be well to indicate some details of its dissemination
during the pre -epidemic period, so that we may be better able to consider whether
new forces came into operation to determine its epidemic 23revalence at a later
period, and, if so, what they were.
Pre-epidemic Period.
Until the end of June, 1900, the numbers sickening increased steadily, but
ga\e way during the autumn months, which were characterised rather by a per-
sistent recurrence of the disease than by the actual numbers sickening. Chiefly,
however, in the early period of increasing prevalence, a notable alteration in the
■distribution of the cases occurred, so that the districts invaded between April and
the end of Ma}^ may be contrasted with those invaded in subsequent weeks. For
this purpose, on Map I. the localities in which cases were recorded in each of the
fortnights ending 21st April, 5th May, 19th May, and 2nd June are distinctively
marked in black, blue, and green dots respectively, and such details of their
association with each other as were at the time discoverable, and are now necessary
to enable their distribution to be followed, are transcribed from the reports of the
several fortnights.
The invasion is thus described in the report to the Health Committee for the
fortnight ending 21st April, 1900:—
For the first time since tlie early winter of 1897,* indigenous cases of Smallpox
have occurred, and the attendant circumstances create some apprehension as to the
future spread of the disease. On 10th April I was asked to see a case of ilhiess by
the medical attendant of a man residing at 3 Tobago Street, and on visiting I found
him suffering from Confluent Smallpox, the symptoms indicating that his attack was
well advanced towards the end of the second week. He had not been brought under
medical observation until the day preceding my visit.
The man had been a seaman on board the s.s. Hispania, which arrived in Glasgow
on 18th March, from Bombay via Liverpool. I had been advised by the Medical Officer
* On 5th June, 1899, there was admitted to Hospital, suffering from Smallpox, a patient from
the Northern District of the City, who had arrived in Glasgow on 23rd May from India, coming over-
land from Marseilles, at which port he arrived on 20th ultimo. His sickness began on 1st June,
which would coincide with exposure to infection about the time of his arrival at Marseilles. There
was no recognised case of Smallpox among the passengers or crew of the steamer in which he came
from India.
10
of Liverpool of the occurrence of Smallpox on board this vessel while at that port, and,,
in consequence, had the crew kept under observation during the time she lay in port
here, i.e., from 18th to 21st March. This patient was re-vaccinated* at Livei-pool with
the rest of the crew, and it had been reported to me that this had been successful, and
that the patient had sailed with the ship on the 21st. Such, indeed, seems to have
been his intention, as he had signed articles for the outgoing voyage, but had failed
to join the ship, and his illness began towards the end of March. After his death no-
evidence of re-vaccination could be discovered.
It is a considerable time since any tenement in Glasgow has been exposed to
such concentrated and continued infection as has occurred here, and the events which
follow are of more than usual interest. Up till the present time (23rd April) eleven
sicknesses have been discovei'ed as the result of this man's illness. All of them, except
the doctor who attended him and a pawnbroker's assistant who received articles in
pledge from his household, are residents on the same stair in which the patient lived.
Three of the cases occurred in the first patient's household — the two others being his
wife and a female lodger — that is, all the inmates thereof. Three others occuiTcd in
a house on the top flat. The others — an unvaccinated child (who has since died) and
its mother — were visitors to the first patient's house, and there are two single cases in
separate households. In all, five households have been invaded, and four out of the
five have been occupied in excess of their legal number. In the first patient's, for
instance, three adults were found in one apartment ticketed for two, while two other
houses, each ticketed for two, and one house ticketed for two and a-half, were each
occupied by three adults and three children. Further illustration of the social habits
of the family first attacked is afforded by the inclusion of the pawnbroker's assistant
among the victims.
Tobapfo Street, where the first patient resided, is in Sub-District No. 11, and
the invaded tenement is marked on Map I. with a circle enclosing a black dot.
In the next fortnight, ending 5th May, six of the recorded cases occurred in
the Central District, and all were traceably associated with Tobago Street, although
at the time of their discovery some were resident elsewhere.
In the Eastern District seven cases were registered, and some details of their
association, and of the migratory character of some of the patients, are given in the
subjoined extract : —
During the fortnight ending Saturday, 5th May, 13 cases of Smallpox were
registered, making 22 in all from the beginning of the outbreak. 12 of these occurred
in the first week of the fortnight, and 1 in the second. The connection of two of these
occurring in the first week with the first case was noted in the report for last fortnight,
and the following details have reference to the remaining 11 registered during the
present one. 3 of the attacks developing in the first week involved three separate
families residing at 3 Tobago Street, and occurred in persons under obsei'vation, while
a fourth, nominally a tenant at this address, spent occasional nights in a Common
Lodging-house, and had slept in one on the night preceding his discovery. A fifth case
was discovered, through information gleaned from neighbours, in the person of a girl
residing at 16 Kirk Street, Calton, who had been a visitor at infected houses in Tobago
Street, but whose name had not been communicated at the time when the earlier
infections were discovered. She was ten days ill when removed to Hospital. The sixth
case was a woman who presented herself at the Central Dispensary for treatment. She
had been resident at 3 Tobago Street during part of the illness of the first patient, but
had left before the natui-e of his illness was recognised, and in the intei-val had changed
* Much correspondence resulted from this statement, and considerable use has been made of it
by opponents of vaccination, who omit to notice the further statement in the report that no evidence
of re-vaccination was discoverable after death. Several months after the incident was thus recorded
the ship surgeon of the Hispania during this voyage returned to Glasgow, and it was then learned
that the re-vaccination referred to in the minute had been performed, but unsuccessfully, during
the voyage from India, in the month of February preceding, because of the occurrence of Smallpox
on board, and that the operation had not been repeated on the occurrence of subsequent cases.
11
her abode — first to a friend's house in 34 Kent Street, leaving this to spend three or
four nights (I7th or 18th to 21st April) in the Moncur Street Model Lodging-house
before taking a room at 139 Stockwell, in which she resided wh^ her illness was
brought to light. Case No. 7 occurred at 69 Main Street, Bridgeton, in the person of
a rag-store worker, employed along with two residents at 3 Tobago Street, one of these
being a lodger in the original patient's house, and now also in Hospital with the disease.
The remaining four cases were in members of one family in Preston Street, Bridgeton,
whose association with the Tobago Street centre cannot be directly traced. They
furnish the only exception in the history of direct association with 3 Tobago Street,
but, taken together with the incidents just recorded, they indicate that the source of
infection has now spread beyond the original centre, and the keepers of Model Lodging-
houses have been advised to be on the outlook for the disease among their patrons.
It is to be observed here that as early as the second fortnight evidence that
the sources of infection were being widely distributed was supplied by the Dis-
pensary patient, the rag-store worker, and the frequenter of the Common Lodging-
house ; while the illnesses in the Preston Street family, which began with the
sickening of the mother on the 20th of April, after a period of confinement to the
house for at least four weeks, brought her probable date of exposure to infection
back to within a day or so of the time (10th April) when the first case was
recognised.
The following fortnights, ending 19th May and 2nd June, showed an extension
of the disease into the North, South, West, and South-Suburban areas ; and as this
latter fortnight brought one phase of the outbreak to a close, the details may be
followed in the report of the period.
(Extract from Report for Fortnight ending 19th May.)
During the first week of the present fortnight 9, and in the second week 12 persons
were admitted to Hospital suffering from Smallpox. This is an increase of 8 on the
number registered during the previous fortnight, and while 5 of the cases occurring
within the first week were in persons under observation in consequence of their associa-
tion with one or other of the cases referred to in last report, none of those occurring
during the second week belong to this category. Of these latter, however, one was
supplied by a woman residing in Gallowgate, who had attended the Central Dispensary
along with the patient noted in last report, and whose name we were in possesion of,
but whose address could not be ascertained, while another case arose in direct association
with this one.
Of the cases not thus accounted for, 2 occurred in the Eastern, 9 in the Northern,
1 in the Central, and 1 in the Western District of the City — a sufficient indication that
the sources of infection have now, as was anticipated from the facts which came to
light in connection with the cases occurring during the previous fortnight, extended
beyond the limits of the originally infected area. This is specially evident from the
distribution of the disease in the Northern District of the City. The earlier cases
occurring therein suggested contact during the hours of employment with some unrecog-
nised case, and this impression was strengthened by the knowledge that several fellow-
workmen had their residence in the neighbourhood originally infected; but the later
cases had no such association, although the dates of sickening in all of them coincided
with exposure to infection in the latter half of April. Indeed, the details of one of those
later cases may be cited, because they illustrate the risks of infection to which the
public are presently exposed, as well as the difficulty which attends the effort to bring
particular attacks into direct connection with earlier cases. The patient in question
is in the service of the Corporation as an attendant at one of the places of popular
resort much patronised during the inteiwals of labour. He sickened on 7th May, but
was able to attend to his duties till the evening of the 12th, by which time the eruption
was at least two days old. As this latter date was a Saturday eftemoon, quite an
12
indiscriminate exposure to infection must have occurred to a large number of persons,
the result of which there is presently no means of estimating ; but the incident will lend
emphasis to the recommendation that, in the present distribution of the disease among
the community, successful re-yaccination should be accepted as the only efficient means
of acquiring protection from accidental exposure to infection.
Again, in the fortnight ending 2nd June, it is noted —
In the North-Western District alone has no case hitherto occurred. As in past
outbreaks, we are again finding that one of the greatest obstacles to efEectively coping
with the disease is the occurrence of an extremely mild and modified form, which
escapes recognition until, as a result, secondary cases of a graver nature arise. The
history of these milder cases is strikingly uniform, and it may help towards a recognition
of this form of the disease to briefly outline it here. In the majority of such cases
medical advice is not sought; indeed, there may be said to be no definite illness —
merely indisposition for a day or two, some little derangement of appetite, and then
a few spots, of the appearance of pimples, on the face, body, or limbs. With the
appearance of these spots the symptoms of indisposition pass off, and the patient is
confirmed in his impression that the attack is a " bilious " one. Tlie subsequent history
of an example of this may be related at length, in the order in which the events came
to knowledge. An employee of the Lighting Department was removed to Hospital
with a well-marked and severe attack of the disease. During the investigation it was
ascertained that a fellow-employee working at the same desk had suffered from a pimply
eruption of the character already indicated, but was absent from work in consequence
thereof only a day and a-half. On examining this latter a few stains only were found,
two at least of which created an impression that they had been produced by Smallpox.
By way of testing this impression he was re-vaccinated (unsuccessfully, as was after-
wards found), and instructions were given to disinfect his house. On proceeding to
carry out this, however, his wife was found actively employed in domestic duties with
a quite recognisable, but very much modified, eruption of Smallpox, about three days
old.
Of a diflierent, but equally suggestive, character is the association of seven cases
occurring near the junction of High Street and Duke Street. Proximity in residence
here led to a comparison of dates of sickening, and these coincided so closely that a
common source of infection was suggested. The information obtained pointed to a
common acquaintanceship of the patients with the household of an eating-house keeper
in the neighbourhood, whose wife, it was then learned, had died after some short-lived
symptoms of acute illness on the night of 13th or early morning of 14th May. She
had been a chronic sufferer from a skin eruption, which renders obscure the description
of her last illness as told by friends, and there was no medical attendant. Hsemon-hagic
Smallpox, however, was suggested by some of the particulars gathered, but, without
being able now to verify this impression, the practical value of the incident lies in the
discovery during this investigation that a daughter of this household was then recover-
ing from an attack of the disease so mild that not more than half-a-dozen spots could
be detected.
One case admitted during the fortnight affords quite a striking, although negative,
illustration of the protective value of re-vaccination. On 14th May a patient was
removed to Hospital from a tenement in the Northern District, seven days ill of the
disease, and on the same day each household in the tenement was advised to accept
re-vaccination of its adult members. All the tenants had this operation performed
save one woman, who sickened on 23rd May, and is now in Hospital with the disease,
her husband, who was re-vaccinated, escaping.
With a vivid recollection of the extensive re-yaccination carried out in the Model
Lodging-houses and Prisons in quite recent years, it is of considerable interest to note
that, although up till the present three Models have had opportunities of "catching
fire," so to speak, from the occasional residence therein of persons in daily intercourse
with houses in which Smallpox was present (in one case, indeed, a patient had already
slept for one night in a Model with the eruption upon him), nothing has as yet occurred
to indicate their successful invasion.
13
With regard to the immediate future, everything points to a period of considerable
anxiety. It cannot be too strongly impressed on the community that our present
knowledge of the distribution of the disease renders it a question of simple prudence
for each to protect himself from risk by re-vaccination. The disease is no longer con-
fined to the earlier associates of the neighbourhood of its origin. One of the most
recent cases occurred in Pollokshields (District 25).
We have now reached the period when a definite invasion of the Eastern
District occurred. In the following tabulation the district distribution of all the
cases recorded in three successive periods ending 2nd, 16th, and 30th June
(including in that ending 2nd June all the cases known to have occurred from the
beginning of the outbreak) are given : —
Period ending.
Central.
East.
North.
South.
West.
S.-S.
N,.W.
Total.
2nd June,
33
18
14
3
2
2
72
16th „
4
27
2
7
40
30th „
10
34
7
5
1
1
58
Of the 9 cases recorded in the Eastern District till the end of the fortnight
ending 19th May, 4, as has been said, formed a detached group in Preston Street,
and 3 others could be referred to an association with Tobago Street. Up till the
occurrence of those now to be considered, there were only 2 others (in the fortnight
ending 5th May), one of whom (residing in William Street, Bridgeton) had a similar
association, but the other (residing in Montgomery Streec) was untraced.
It will lend greater precision here to take the dates of sickening in preference
to the period of notifications, and in the Map II. the eastern cases only which
sickened in the fortnights ending 2nd, 16th, and 30th June are indicated, by black,
blue, and green dots respectively. In the several fortnights these numbered 16,
29, and 22, and had the following distribution : — -In the fortnight ending 2nd June
a grouping occurs round Steven Parade, immediately to the west of the Hospital ;
two are situated in the neighbourhood of Dechmont Street, to the north ; and
several are more widely distributed, especially towards the lower end of Springfield
Road, Baltic Street, and Boden Street. In the fortnight ending 16th June a more
definite grouping occurs in the neighbourhood of Baltic Street, and generally in a
south-westerly direction from the Hospital ; while in the fortnight ending 30th
June there occurred a congeries of cases round a tenement in London Road, under
the following circumstances : —
(Extract from lieport for Fortnight ending 30th June, 1900.)
The most striking incident in the histoiy of the disease during the fortnight was
occasioned through the notification of a case in a tenement in London Road, and the
subsequent discovery, as a result of house-to-house visitation, that for about two weeks
the disease had been present in another household in this tenement, and that several
others had subsequently been invaded, in addition to the one in which the notified
case occurred. The patient whose attack stands related to all these others as the
source from which their infection was derived was a girl who, when discovered, was
in an advanced stage of the disease — progressing, in fact, towards recoverj^ but still
in a highly-infectious condition. Her illness had been a moderately severe one, as
judged by the crusting present on discovery, but she had no medical attendance, and
14
intercourse between the members of her household and the community was unrestricted.
Smallpox infection takes full advantage of the opportunities thus offered for spreading,
and a record of the cases presently known to have resulted from this one is instructive.
House-to-house visitation of the tenement resulted in the discovery of eleven cases in
seven households, and there has since been notified or discovered a neighbouring shop-
keeper doing business with the tenants of this land; a fellow-worker with a member of
the originally infected household ; three visitors to the tenement, one of whom resides
in the Eastern and two in the Northern Districts of the City — all of which can be
relegated to infection derived from this source.
In addition to these 16 cases, 10 others occurred in the Eastern District who were
associated with each other, or with cases in the previous fortnight, and there were 6
others for whom no such association could be discovered.
In the other districts of the City, 9 occurred in the Central, 6 being associated
cases; 7 in the Northern District, only 1 of which had no traceable association with
the others ; and 5 in the Southern, 4 of which had a traceable coimection. The South-
Suburban District and the Western had each 1 case. In all 58 cases were registered,
against 40 for the previous fortnight ; but it may be observed, as affording some ground
for satisfaction, that the majority are coming under notice earlier in the illness than
formerly, and the chances of secondary infections from them are, in consequence, con-
siderably lessened.
Occupational Incidence.
The occupational incidence of the attacks so far serves only to indicate the
wide distribution of the disease among the industrial population, without presenting
any contrast between the occupations of those attacked before and after the
beginning of June. Prior to 2nd June 41 were males and 57 females. During
June there were 37 males and 35 females.
During July and August the numbers sickening considerably diminished;
gradual dissemination through unrecognised mild attacks of the disease took place ;
and the difficulty of stimulating popular interest regarding the probable nature of
illnesses, however mild, when accompanied by eruption, was again proving an
obstacle to the early recognition of cases.
An enquiry with regard to the probable sources of infection of 48 cases
recorded during the four weeks ending 11th August showed that in 14 cases only
could this be ascertained : —
Fortnight,
Fortnight,
28th July.
11th Augnst.
5
9
Associated with previous cases.
13
10
Occurring in infected neighbourhoods.
7
4
No definite association with known sources.
Renewed activity began towards the end of November. In the fortnight
ending 1st December, 21 cases had been reported, and in each of these ending
15th and 29th, 36 cases, the numbers contributed by the Eastern Districts being
respectively 17 in the first and 18 in each of the later fortnights.
In Map III. the distribution of the cases occurring in each of these fort-
nights is distinctively marked, and it will be seen that while those occurring in
the fortnight ending 1st December are widely distributed over Districts 5, 7, and 8,
there is a definite grouping in the next fortnight in one part of No. 5, and in
the second fortnight in District No. 7, towards Nuneaton Street, and again at the
foot of Springfield Road.
The following incident in connection with a threatened invasion of the City
Poorhouse which occurred at this time is worthy of note : —
15
City Pooehouse.
Early in December two cases were simultaneously recognised among inmates of
the City Poorhouse, one of whom had been resident from the previous S_p.ptember,
wliile the other had been admitted only three days previously, his sickness having begun
two days before that. They were in separate wards, and the suspicion created by the
indigenous case that infection had been introduced either by a modified and not recog-
nised attack or through visitors was confirmed on the following days by the occurrence
of other cases. The dates of sickening were as follows: — 5th, 7th, 12th, 13th, and 14th
December; while, as has already been said, another inmate, admitted on the 6th of
December, had already sickened on the 4th.
On the Poor Law Authorities becoming aware of the gravity of the outlook, the
services of the whole medical stafE were called into requisition for the purpose of re-
vaccinating both inmates and applicants for relief, and it was subsequently reported to
the Health Committee that in the City Poorhouse 1,610 and in Barnhill 360 inmates,
and 551 applicants, had been re- vaccinated.
The result of this vigorous action by the Poor Law Authorities was that no
subsequent cases occurred among the inmates until the following winter, when the
personnel had considerably changed.
*
Epidemic Period.
By this time we had reached the beginning of the epidemic period of the
outbreak, to which the following extracts refer: —
(Extract from Report for Fortnight ending 12th January, 1901.)
During the fortnight 16 cases of Smallpox occurred in the Eastern District, 6 in
the Central, and 1 in each of the Southern ,and Western Districts — a total of 24,
against 36 in the preceding fortnight. Notwithstanding this reduction in the number
of cases registered, the outlook is not reassuring, and the approaching months are
likely to see a still further extension of the disease. Among the causes for apprehension
is the indifference with which the milder forms of the disease are being regarded. The
following is an illustration : — On New- Year's Day a case of suspected Smallpox was
reported from Commerce Street, and the patient, on being visited, was found to have
been only a fortnight in Glasgow, and for the most of that time to have lodged with
a family in Argyle Street, where he had sickened on 28th December, and, in con-
sequence, had been removed to a friend's house in Commerce Street. Coincident with
this case being recognised, a telegram was received from the Medical Officer of Health,
Aberdeen, stating that a case of the disease had developed there in the person of a man
who had also been a lodger in the Argyle Street house, but had gone home for the
holiday season. Enquiry at this house resulted in the discovery that one of the inmates,
a girl, was still suffering from an attack of much modified Smallpox, but had recovered
sufficiently to admit of her returning to worlc, in a tea-room in the City, for the last
week of the year. It was further found that a younger sister liad sickened of a still
milder form of the disease a fortnight earlier — that is, in the end of November — so
that for five weeks previous to the New Year this house had been in an infectious
condition, while the inmates were pursuing their usual avocations. Neither patient
had been under medical treatment. This incident occurred in a house of six apartments,
inhabited by a family of eight persons, in addition to which there were seven lodgers,
four of whom were still in residence, and tliree had either removed or were on holiday
— one being at an unknown address in Morayshire when he sickened of tlie disease,
but returned to Glasgow before its nature was recognised. On tlie circumstances being
brought to the notice of the management of the tea-room in question, twenty-three mem-
bers of the staff were re-vaccinated, and the period of incubation has now passed without
any sickening among them having occurred. Seven cases in all, however, arising out of
direct association with the household, have, up till the present, been discovered. One
of these, a visitor, residing at Great Hamilton Street, afforded an excellent illustration
16
of how a mild form of the disease may give rise to a more severe form in a person not
protected by vaccination. The patient in this instance had visited several times
during the currency of the disease at Argyle Street, and on 28th December sickened ;
she was unvaccinated, aud her attack became confluent. .
The indifEerence to effective re-vaccination on the part of the general population
is much to be regretted in the present position of Smallpox in the City. In connection
with the cases reported during the fortnight, 599 persons were re-vaccinated in the
tenements where the cases occurred, or in the workplaces in which they were employed,
but 19 only of the general public took advantage of the opportunity of free vaccination
offered by the Health Committee through medical practitioners. Smallpox is at
present widely distributed, and the temporary inconvenience which re-vaccination gives
rise to is a trifling consideration to place against the absolute protection from the
disease which it ensures. District visiting and the work of the various philanthropic
and charitable organisations of the City can only be conducted with safety at the present
time by those who are fully protected by vaccination, and we must look for a large
extension of the disease in our midst unless voluntary effort is made by every section
of the community to obtain the protection which re-vaccination affords.
[Extract from Report for Fortnight endmg 26th January, 1901.)
During the fortnight 350 cases of Smallpox were registered, and the resources of
the administration have been taxed to a degree quite unknown in recent years.
In the Eastern District alone 256 of these cases occurred; in the South and South-
Suburban there were 70; in the Central, 14; in the Northern, 6; while the Western
and North- Western Districts have each 2 cases.
In the Eastern District the majority of the cases have occurred in certain well-
defined groupings, which constitute infected areas within which the disease has assumed
epidemic vinilence, and in the Southern District a similar tendency is likewise mani-
fest, although in a more limited form at present.
The areas in the Eastern District in which this has occurred are —
(1) Parkhead generally, but with a tendency towards aggregation at the upper end
of Dalmarnock Street and streets adjacent thereto, in Westniuir Street and
in the streets adjoining, and in the line of Great Eastern Road towards the
eastern boundary of the City.
(2) London Road and streets east of Bridgeton Cross, and again beyond its junction
with Springfield Road.
(3) Dalmarnock Road.
(4) Springfield Road.
(5) Main Street, Bridgeton.
In the Southern District the area lies between Caledonia Road and the River, and
extends eastward in the direction of Oatlands, while sporadic cases have occurred in
Crossbill, Langside, and Mount Florida.
The rapid extension of the disease in this form requires the concurrence of two factors,
which may be thus stated — the free movement of mild and unrecognised cases, and
a population largely susceptible to the disease from inefficient vaccination. A com-
parison of the dates of sickening in a very striking mamier demonstrates the circum-
stances under which this took place.
I have been able to ascertain those dates in 306 of the cases registered, and reproduce
them here —
17
Dates of
IN U HI U c I o
Pates of
N umbers
Sickening.
Sickening.
Sickening.
Sickening.
Brought forward,
ou
December
.JO LXlj
January
J)
jyin, ...
i
•)
i.3tn.
owtn,
J
?)
1 If It
22
^1 of
!)
1 PifVi
1 0 xjli , ...
January
X o Uj ...
1
1
J5
1 fifVi
i 0 Lll,
•^o
•)
. . .
?*
17th,
)i
3rd,
1 J
18th,
40
)S
4th,
i
19th,
30
)!
5th,
; )
20th,
23
J>
6th,
—
)!
21st,
16
))
7th,
•J
22nd,
5
)!
8th,
3
>?
23rd,
1
))
9th,
7
)>
24th,
•>
10th,
15
J?
25th,
!!
11th,
10
26th,
Carry foricard.
39
308
Dealing, in the first jDlace, with the days on which the number sickening was greatest,,
we have a period, extending from the 13th to the 21st January, in which 256 persons were
attacked, and the scale of attacks rises towards the I7th, when 43 persons sickened.
The period of incubation of Smallpox varies from the ninth to the seventeentli day
after expostire, the majority sickening about the twelfth day. The I7th of January
would therefore correspond to exposure to infection on the Saturday of the New Yeai^
holidays (5th Januaiy).
By the 7th of January most persons had returned to their ordinary occupation, and
the rapid decline in the sickenings occurring in the third week of the year is quite as
striking as the rapidity of the increase, which began more than a week earlier.
This analysis might be joushed somewhat further into an exjilanation of the number'
sickening between the 8th and 12th, fifteen persons having sickened on 10th January,
which again corresponds with an exposure at the end of Christmas week, when many
of the observances of the season had in part commenced.
The outbreak is, therefore, definitely related to exposure to infection occurring
during the holiday season.
The localities involved correspond very closely, it will have been seen, with those
in which isolated cases of the disease were known to have been occurring for some con-
siderable time past; in these districts, therefore, there has been a succession of cases
quite unrecognised owing to their mildness, but gradually, from their numbers, acquiring
an explosive intensity which only required a suitable occasion to show itself. This
came with the holiday season, when intimate co-mingling occurred, and the mild cases
had for the tune being a newly-established relationship. That this has proved to be
a susceptible one almost beyond belief brings home most forcibly the need for statutory
re-vaccination if communities are to be protected from recurring outbursts of the disease
at intervals of years.
In June last the Health Committee, in view of the then distribution of Smallpox,
recommended the population to have recourse to re-vaccination, and, by way of placing
at the disposal of every one who was unable i^o pay for the operation an opportunity
of having it done, a fee was paid to practitioners for all such operations performed by
them. The result of this appeal was extremely disappointing, and even under con-
ditions of direct exposure to infection we not unseldom found that an offer of re^
vaccination was refused. Several of these, it must be added, are now in Hospital with
Smallpox, and in two instances at least death has occurred.
At the present moment the numbers before us indicate that the rush of cases
created by the holiday period has passed, but a secondary rise is likely to occur at a
period corresponding to infection on the I7th, which is the day on which the maximum
amount of infection is known to have been present among the population. The present
18
lull in the occurrence of cases is, therefore, not to be taken to indicate that the danger
is past.
It may be interesting at the present time to point to the complete exemption from
the disease enjoyed by the Post Ofi&ce service. The members of this service, probably
more than any other in the community, are brought into quite definite relationship
with every infected area, and yet no case of sickness has occurred among tliem. It is
a condition of this sei-vice that each member be efficiently re-vaccinated.
In the four weeks which followed a steady decrease occurred in the numbers
registered fortnightly, but this was again followed by an increasing prevalence,
indicated first by the number of admissions to Hospital in the last week of February,
which collectively did not equal that which we have just seen, but extended
throughout a period of three weeks, and, in consequence, created greater public
apprehension than the larger volume of the earlier rise.
{^Extract from Report for Fortnight ending 9th March, 1901.)
The cases of Smallpox registered during the fortnight numbered 299, and their dis-
tribution over the several districts is shown in the following Table, the numbers for the
three preceding fortnights being given for comparison —
Fortnight ending
26tli Jan.
9th Feb.
23rd Feb.
9th March.
Eastern, -
256
104
67
219
Central, -
U
20
20
30
Northern,
6
22
11
18
Southern, -
53
37
17
26
Western, -
2
4
2
2
South-Suburban,
17
14
7
3
North-Western,
2
1
3
1
350
202
127
299
After an interval of diminishing prevalence of the disease, extending from 1st to 19th
February, an increase again began, which was first indicated in the number admitted to
Hospital on 23rd February. The recrudescence in the Eastern, Central, Northern, and
Southern Districts may be stated as an increase of 155 per cent, on the numbers registered
during the previous fortnight, but vaiying from 227 per cent, in the Eastern to 50 per
•cent, in the Central District. In relation to population, there were 13 attacks per 10,000
living in the Eastern District, less than 3 in a similar number in the Central District, 2 in
the Southern, and 1 in the Northern.
The occurrence of this increase after an interval which is longer than the maximum
period of incubation displaces it from the swing of epidemic movement which marked
17th January and 1st February. Wlien the increase in January occurred there was a
definite time relationship between the period of sickening and the preceding holiday
season. No incident of a similar character occurred by which the rapid increase in the
numbers sickening from 19th February may be accounted for. A comparison of the
dates of sickening of these latter cases points to the end of the first week of February as
a period when an active dissemination of the disease took place. It was at the end of this
week that the daily number of patients under treatment was at its greatest, a fact which
undoubtedly suggests the introduction of a new factor, the operation of which was most
probably intensified by the seasonal conditions under which it occuiTed.
In the fortnight ending 23rd March 161 cases were registered, and thereafter
the outbreak rapidly declined. In the two periods of greatest prevalence just
referred to the following numbers were registered : —
Fortnight ending
26th January, 9th February, 9th March, 23rd March,
350 202 299 161
19
Pebiod of Recrudescence.
The history of this may be shortly told. The disease first reappeared in the
Northern District of the City, and. in contrast with what had occurred during
the greater prevalence earlier in the year, certain Model Lodging-houses were now
invaded, owing to the unrecognised presence of cases of an exceptionally mild type
in one of them during December.
In the early weeks of the recurrence the cases were chiefly drawn from the
Northern District, but in the fortnight ending 22nd February, of a total of 147 new
cases occurring throughout the City, 102 occurred in the Eastern District, and
the distribution generally reverted to the lines it had followed earlier in the year.
The following extracts contain a description of the principal features which it
presented : —
{Extract from Report for Fortnight ending 16th November, 1901.)
The first case of Smallpox which is linown to have occurred in the City since 29th
June last was admitted to Hospital on 6th current. The patient is a spirit salesman,
employed in the Northern District, and also residing there. He sickened on -Slst October,
leaving work on the following day, but liis illness was believed to be Measles until 6th
November current, v/hen some doubt as to its nature arose, and we were informed thereof.
Patient occupied a house of two apartments; his family includes his wife and two young
children, and there were three male lodgers. He had not been re-vaccinated in
spring, while in his wife and one lodger the operation was tlien imsuccessful. Two
possible explanations of the source of infection offer themselves, but in the absence of all
trace of illness among his intunates, the possibility of his obtaining it tlirougli any channel
of missed infection remaining from the outbreak in spring is less probable tlian that it
has reached him through one suffering from a mild attack of the disease. It is consistent
with all that is known of the conditions determining the incidence of Smallpox that a
recurrence of the disease in dissociated centres is now to be expected, that our present
case is only the first illustration that mild and unrecognised cases most probably already
exist, and that, in consequence, the occurrence of subsequent disconnected cases is to be
anticipated as the winter advances. All the known contacts have been placed under
supervision, the household being removed to the Reception House, where those formerly
unsuccessfully re^vaccinated have since been done.
In this and the adjoining tenement 50 out of 76 persons over five years of age had been
re-vaccinated in spring. Two only of those remaining could be persuaded to takei
advantage of tlie offer of re-vaccination again made on the occurrence of the present case.
"The census showed that the number of persons over five years of age within the
municipal area exceeded 670,000. The total number of recorded re-vaccinations among
these amounts to slightly over 400,000.
{Extract from Report for Fortnight ending 30th November, 1901.)
During the fortniglit 5 cases of Smallpox Avere registered, as against 1 in tlie pre-
ceding fortnight. The first of these five was reported on 20th November, having sickened
on 14th November, while i^esident in a Model Lodging-house in the neighbourhood of
Garscube Road. The source of this patient's infection was not ascertained until 26th
November, when a second case (M.), residing in 202 Possil Road, was notified.
Here the patient had sickened on 20th November, and, on enquiry, a tliird case (C),
a neighbour, was found to have sickened on 21st, and a fourth (J. K.) on 14th November.
All of these are secondaiy to an attack in a fifth (K. D.), whose illness began on 31st
October, and who had almost recovered by tlie time tlie other cases came to be mvesti-
gated. There is a close correspondence between the beginning of this last patient's
illness and that of the patient reported last fortnight. Both sickened on 31st October,
but othei-wise they appear to have nothing in common. None of the six cases in
Hospital had been re-vaccinated.
In tlie tenements in the immediate vicinity of the infected one at Possil Road, it
has been found that during the vaccination last spring 279 persons out of 413 persons
20
living over five years of age, or 67 per cent-., were re-vaccinated, and this has been
raised to 84 per cent, as the result of the present cases.
Since May last, however, re-vaccination has practically ceased among the general
public.
(^Extract from Report for Fortnight ending lJf.tlh December, 1901.)
The cases of Smallpox known to have occurred during the fortnight were four in
number. One attack was due to infection contracted in London, two were associated
with the cases reported last fortnight occurring at 202 Possil Road, and the fourth case
occurred in Springburn, and had no discoverable connection with any other.
In the first case patient arrived on 29th November from Tilbury, and sickened
on the following day, the rash appearing on 2nd December. The family which this
patient was visiting in Glasgow consisted of five adults, three of whom had been re-
vaccinated last winter.
The cases occurring in association with Possil Road are —
1. R. G., residing at Rodney Street, sickened on 1st December, the eruption
appearing on the 4th. Patient had friends at 202 Possil Road, and was a frequent
visitor there. Although she appears not to have visited after 18th November, she was
visited subsequently at her own house by persons from that address.
2. Mrs. P., residing at 210 Possil Road. 210 is the front land to which those
tenements entered from 202 form the back building. The husband of this patient is
employed in connection with some alterations being carried out in the houses in which
former cases of Smallpos had occurred, and he himself had been re-vaccinated.
The Springburn case sickened on 2nd December, the eruption appearing on the
4th. This patient had no vaccination mark, and says she understands she never was •
vaccinated.
(^Extract from Report for Fortnight ending 11th January, 1902.)
In the first week of the fortnight twenty-three cases of Smallpox were admitted to
Hospital, in the second week five cases.
These, with two exceptions, occurred in persons who, at the time they contracted
the disease, were inmates of, or visitors at, a Model in the Northern District, and they
afford another illustration of what will happen when a mild case is permitted to live
among persons who are only partially protected by vaccination. This Model had been -
under observation during November, and, although an interval of freedom from infection
occurred between the case then removed and the first of the present series, we may
regard them as at least indirectly associated.
The outbreak was brought under notice in the following circumstances : — On 30th
December the Local Authority of Ayr intimated that a man who had lived in this
Model between the 7th and lltli of December had sickened in Ayr on the 22nd, and,
while enquiry was being made into this, another inmate applied for parochial relief,
and was recognised to be suffering from the disease.
The enquiry in the Model had already led to the discovery of two other cases;
subsequently a man was discovered whose eruption went back to 6th December.
Directly associated with this man are twenty others resident in the Model, one being
the Superintendent, who had, on the occasion of the case in November, assured us that
he had been re-vaccinated last April, and only admitted the error of his statement when
his attack declared itself; two living in Models elsewhere; a bedmaker in the Model,
but living in M'Adam's Lane ; one in Possil Road and one in Bernard Street, in the
Eastern District, both of whom were occasional visitors to the Model in question. On
the recognition of the outbreak the owner was informed that he must cease admitting
new inmates, and a circular was addressed to the keepers of all Model Lodging-houses
advising them of the occurrence, and inviting their co-operation in the discovery of
suspected illness. The affected Model is under nightly medical examination.
In this Model 143 persons were re-vaccinated, and of 83 examined within the fort-
night 44 had proved successful and 39 unsuccessful.
In addition to these twenty-six, two other cases occurred during the fortnight, one
in St. Vincent Lane and one in a Model in the Eastern part of the City, and neither,
so far as is known, has any association with the group in the Northern District. With
21
i-egard to one of the admissions, a male patient, aged tliirty-tliree years, named W. B.,
it falls to be observed that he says he was successfully re-vaccinated three years ago
in one of the Models, and that two marks exist. This is a further illustration of what
has already been said in connection with the cases occurring last year.
[Extract from Report for Fortnight ending 25th January, 1902.)
During the fortnight 2.3 cases of Smallpox occurred, as against 28 in the preceding
fortnight. Of these, 6 were removed from the Model Lodging-house in the Northern
District referred to formerly ; 4 were removed from other districts, but had been resident
in the Model at the time of contracting the disease ; 6 were indirectly associated there-
with; and 7 had no traceable association. Of those contracting the disease in the
Home, one had, prior to sickening, gone to reside in the Western District ; a second
sickened in the Model late in December, but had gone soon thereafter to reside with
a friend in Possilpark, and his illness was only recognised when his friend developed
the disease; a third was admitted to the City Poorhouse, also late in December, and
thereafter developed the disease in so mild a fomi that its nature was not recognised
until a second inmate sickened; and a fourth was known to have been present with a
Smallpox patient in the consulting room of a surgeon, and refused at the time to be
re-vaccinated. His attack affords another illustration of the selective action of the
infection of Smallpox, because the others then present in tlie surgery (save a young
boy) had been re-vaccinated last spring, and none have been attacked save himself.
Of the 6 associated cases, 2 were removed from the City Poorhouse, 1 from Bridge-
ton, 1 from Possilpark, and 2 from the Northern District.
Early in the fortnight one case in Bridgeton was brought to notice, and the circum-
stances suggest that endeavours had been made to suppress knowledge of its existence.
The patient, a child aged ten years, on being seen, had been ill and was confined to bed
for over two weeks; she was unvaccinated, as was also her sister, who, along with the
father, have since developed the disease, and are now in Hospital.
[Extract from Report for Fortnight ending 8th February, 1902.)
23 cases of Smallpox were registered during tlie fortnight, compared with a
similar number during the previous fortnight, the distribution remaining much as
formerly, 13 having occurred in the Nortliern District, 4 in the Central, and 3 in each
of the Eastern and Southern Districts. Inmates of Model Lodging-houses still supply
the majority of the cases from the Northern District, 3 having occurred in that which
was originally infected and 6 in another Model in the neighbourhood. The other cases
here were removed from Church Place, Cowcaddens, Mary Street, and Springburn Road,
one only being traceably associated with the Model cases.
In the Model which became secondarily infected there were several inmates who
had formerly been seen as visitors in the other.
Of the 3 cases occurring in the Central District, 2 were in Model Lodging-houses,
.and 1, removed from the Calton District, is associated with a case in the previous
fortnight.
Of the cases occurring in the Eastern District, one is father of the child referred
to last fortnight as affording illustration of an endeavour to conceal the existence of
the disease; a second is an unvaccinated baby who has been taken to visit this house-
hold, but information thereof withheld until the sickness occurred; while a tliird was
a worker in the Provanmill Gas-works, and associated with a case in the North Wood-
side District.
Of the 3 cases occurring in the Southern District, 1 is associated with a case in
Struthers Street; 1 was a lodger in tlie house of the case removed during the previous
fortnight, and was, at the time of sickening, under observation in the ReceiDtion House ;
and in 1 the origin of the disease cam:iot be traced.
{Extract from Report for Fortnight ending 22nd February, 1902.)
The most striking featui-e in thci movement of this disease during tlie past fortnight
has been the sharp increase in the number of cases occurring during the first week.
Between November, when the first cases of the present recrudescence of tlie disease began,
and the end of December, only 10 were known to have occurred in the City, 9 of which
were in the Northern and 1 in the Southern District.
22
In the first fortnight of this year a definite association of cases was discovered, as-
described at the time, in a Model Lodging-house, also in the Northern District, and of 84
cases in all reported prior to the end of the fortnight ending 8th February, 59 were in the
Northern and only 8 in the Eastern District of the City. During the fortnight just closed,,
however, the area of distribution has not only widened, but the incidence has changed, asi
is shown in the following Table : —
Central. Eastern. Northern. Southern. Western. S.-S. N.-W. Total.
16th Nov., - ... ... 1 ... ... ... ... 1
30th „ - ... ... 5 ... ... ... ... 5
14th Dec, - ... ... 3 1 ... ... ... 4
28th „ - ... ... ... ... ... ...
11th Jan., - 2 1 24 ... ... ... 1 28
25th „ - 4 3 13 2 1 ... ... 23
8th Feb., - 3 4 13 3 ... ... ... 23
9 8 59 6 1 ... 1 84
Fortnight
ending 22nd Feb., 12 102 14 7 3 2 7 147
21 110 73 13 4 2 8 231
The circumstances just related demonstrated the need for reverting to active
re-vaccination in the Eastern District, and the Special Committee authorised the
employment of twelve additional vaccinators, who, with the Inspectors, form a corps of
about thirty-one officers, which is nightly engaged, chiefly in the Eastern Districts in
infected tenements, but generally wherever we have reason to believe that vaccination
has been imperfectly carried out.
{^Extract from Report for Fortnight ending 8th March, 1902.)
During the fortnight 92 cases of .Smallpox were registered, as against 146 for t\e
previous fortnight.
Of 39 cases occurring in the Eastern District, 29 occurred in Districts 7 and 8.
Of the cases in the Western J)istrict, 12 have been associated with a hotel there,
either directly or at the time they contracted the disease. As a result of this, it has been
necessaiy to instruct the proprietor to prohibit new admissions until a fortnight has
elapsed without any new case occurring. The staff and a considerable proportion of the
visitors accepted re-vaccination.
During the fortnight the first illustration has occurred of Smallpox attacking one.
of the employees. In this case the patient is a washerwoman, employed at the washing-
house, Belvidere, who was permitted to begin work without being re-vaccinated.
Several illustrations have also occurred where the sickness only developed after a
period of complete confinement to the house for longer than the period of incubation.
This has been especially noticed in connection with several cases in the Southern District
of the City, and suggests the diffusion of the disease by vagrants or itinerant vendors of
small wares. We are also having repeated illustrations of the selective power of Smallpox
infection in the occurrence of the disease in families where the patient alone is the only
member unprotected by previous re-vaccination.
The vaccination corps has been further reinforced, so that now about forty operators
are engaged nightly in pressing re-vaccination in the infected districts. An almost
complete apathy, however, prevails, and little re-vaccination is accomplished save in
tenements where cases occur.
Little advantage is being taken of the arrangements formerly made, by which a fee
is paid by the Corporation for successful re-vaccination of citizens by medical practitioners.
The details of the district distribution down to May, 1902, is contained in
Table III. Up till 5th April the disease in District 7 had reappeared in 36
instances in a tenement from which cases had been removed during 1900-01, but
in no case was there a recurrence in the same house, nor were any patients admitted
in whom there was evidence of successful re-vaccination having been performed
during the earlier period of the outbreak.*
* See Kote of 11th January, 1902.
23
DISTRICT DISTRIBUTION.
The number of cases admitted to Hospital, including 61 from beyond the
City boundary, in each of the periods was as follows : —
Cases. Deaths. Case-Mortalitj'.
Pre-epidemic Period —
April— December, 1900, ... 387 46 11-9
Epidemic Period —
January— June, 1901, 1,423 192 13-5
Recrudescence —
November, 1901— 3rd May, 1902, 469 ? ?
Pre-epidemic and Epidemic Periods.
Till the close of the epidemic period the cases numbered 1,759, only 10 of
which were not removed to Hospital, the attacks having ended in death or recovery
at home before their nature was recognised. Two hundred and thirty-four deaths
occurred. These figures represent an attack-rate for the whole population of 2'3
per 1,000, a death-rate of '3 per 1,000, and a case-mortality of 13'3 per cent.
In Table IV. (p. 24) the population of each Sanitary District, the rmmber
of cases and deaths, and the rate per million of population is stated, the grouping
of the districts being arranged from those in which the disease was most prevalent
to those in which it was least so. The cases occurring during the recrudescence are
not included.
The unequal incidence of the disease here shown will best be appreciated by a
comparison of the attack-rate in the several districts.
Greenhead and London Road (District 7) had an attack-rate of 9 9 per 1,000
living, which is fully six times that of the other districts, and fully four times that
of the City generally. Next in point of severity of incidence comes Barrowfield
(District 8), which lies between the Greenhead and London Road sections of District
7), with an attack-rate of 6'4 per 1,000. District 11, where the outbreak began,
stands third, but here the rate is less than half that of District 7, and barely twice
the City rate.
Further comparison will be simplified by grouping the districts according to
their administrative divisions, as in the following Table : —
Population, Cases, and Deaths in each Administrative District.
Administrative District.
Population.
Cases.
Deaths.
Rate per
Million.
Case-
Mortality
per Cent.
Cases.
Deaths.
Eastern,
173,104
1,063
134
6,141
692
12-6
Central,
111,784
216
31
1,932
277
14-4
Southern,
132,718
239
30
1,801
226
12-6
Northern, ...
166,825
123
19
737
114
15-4
"Western,
61,092
62
9
851
147
17-3
South Suburban, ...
64,205
55
10
857
158
18-1
North-Western,
51,984
11
1
212
19
9-1
City,
761,712
1,759
234
2,309
307
13-25
24
Table IV. — Return of Cases and Deaths in each Sanitary District.
Cases.
Deaths.
Sanitaky Districts.
Population.
Number.
Rate per
Million.
Number.
Rate per
Million.
Eastern.
/. Greenhead and Jjondon Koad,
00, 197
660
9 970
7^>
1 1 0"^
8. Barrowfield, ...
1 /,o9o
179
fi 4.fi3
9fi
.5. Bellgrove and Dennistoun, . . .
70 Oil
224
9 S98
Central.
11. Calton,
22,169
94
4,240
12
541
6. High Street and Closes East,
7,102
21
2,907
282
9. Monteith Row,
4,267
1
1
9^1
1-3. Brownfield,
3,924
10
12. St. Enoch Square,
Q AAA
\
000
14. Bridgegate and Wynds,
o,ooU
6
1 54fi
\
1. Exchange,
-J4,4:0 i
34
1,392
S
327
10. St. Andrew Square,
4, / y*
5
1,043
1
209
3. High Street and Closes ^Vest,
9,669
8
827
1
103
Bl. Blythswood,
28,548
22
770
4
140
South.
2 1 . Hutcheson Square,
146
2,079
18
256
Z/. (jiorbais.
1 OjUyo
94.
1,833
9
19. Kingston,
63
1,559
10
247
20. Laurieston,
o,yoo
6
668
North.
4. tet. rlollox.,
1 OAT"
io,yu /
31
1,948
6
377
1 6. Cowcaddens, ...
io, JOo
19
L043
4
220
— Springburn and Rockvilla,
35,527
26
732
3
84
3 1 . Possilpark and Barnhill,
21,694
11
507
1
46
1 5. Woodside,
70,145
34
485
5
71
2, Port-Dundas,
5,346
2
West.
18. Anderston,
28,858
40
1,386
7
243
17. Kelvinhaugh and Sandyford,
32,234
■^79
0 1 ^
9
fi9
South-Suburban.
24. Crosshill,
7,626
11
1,442
2
262
23. Govanhill,
23,191
26
1,121
5
216
27. PoUokshields, West, and Bella-
houston.
5,711
5
875
25. Langside and Mount Florida,
14,847
9
606
1
67
26. PoUokshields and Strathbungo,
12,830
• 4
312
2
156
North- West.
28. Hillhead,
8.537
4
469
30. Maryhill,
3.5,657
6
168
1
28 .
29. Kelvinside,
7,790
1
128
761,712
1,759
2,309
234
307
Question of Hospital Influence.
During the progress of the outbreak it became obvious that some circum-
stance not essential to epidemic movement was determining this undue prevalence
in the Eastern District.
We have already seen that early in June, 1900, an indication of this had
occurred. As the outbreak developed, although in actual numbers the cases
from this district were largely increased, their relative proportion to cases occurring
elsewhere was only slightly raised.
During the epidemic prevalence of the disease early in the seventies, a similar
aggregation of cases occurred around Parliamentary Road Hospital, and we may,
by comparing the district distribution in some of the intervening years, discover
whether this concentration of cases in the neighbourhood of the hospital takes
place only when smallpox is epidemic, or whether it occurs also at any time when
cases have to be dealt with.
In the following Table this is calculated for each of the years in which Smallpox
was present in the City since 1892, and, for purposes of comparison, the distribution
of the cases in 1900-1901, and the proportion of population residing in each of the
districts is included : —
Smalllpox. — Peoportion from each Administrative District op the Total Cases
OCCURRING in SeVERAL YeARS.
Percentage of Total Cases.
Year.
Total
Cases.
East.
Central.
South.
North.
West.
S.S.
N.W.
1900-\
1901 /
1,759
60-4
12-3
13-6
7-0
3 0
31
•6
1892
78
28'2
19-2
26-9
3-9
20-5
1-3
1893
386
45-9
24-7
9-7
128
3-8
•8
2-3
1894
49
32-7
36-7
16-3
8-2
2-0
4-1
1895
243
33-4
140
90
5-8
36-2
•8
•8
1896
5
1897
59
57-6
3-4
32 2
5-1
1-7
Percentage
Population, 1901,
1 23
15
17
22
8
8
7
In each year, therefore, in which smallpox has been present the proportion of
cases contributed by the Eastern District has been uniformly in excess of the
proportion of the population residing there.
The Central, Southern, and Western Divisions in occasional years present a
similar excess, but this is due in most cases to the circumstances under which the
several outbreaks were introduced. The excess in the Eastern District is constant^
and in none of the other districts is this feature present.
26
When the Eastern prevalence began in June, 1900, the ilumber of cases in
Hospital was comparatively limited, and it is reasonable to assume that, if simple
aggregation of smallpox creates an element of risk to surrounding populations,
this risk should increase with the densit}^ of the aggregation, and result in
an exaggerated prevalence in those districts which are exposed to it when compared
with those which are beyond its influence.
Could a gradation of risk be thus established, the question of site for such
hospitals would be simplified, because it might be assumed that some standard of
cubic space per patient could be found at which risk would be reduced to a
minimum, if not entirely abolished.
In the preceding Table there is a rough indication of this in the years 1895,
1893, and 1900-1, when the numbers dealt with were 243, 386, and 1,759 respec-
tively, and the proportion of Eastern cases 33, 46, and 60 per cent.
The occurrence during the present outbreak of a period when the disease
might be described as prevalent, as distinguished from a subsequent period of
epidemic intensity, afforded a further opportunity of comparing the effect which
might be attributed to simple aggregation in Hospital with that occurring during a
time when the demand for accommodation introduced an element of density in
the aggregation, and necessitated a reduction of cubic space per bed.
The proportion of the total cases occurring in the several districts during each
of these periods is as follows : —
Administrative District.
Percentage
Popiilation
Proportion per cent, of Attacks
TO Total Attacks in each Period.
(Census 1901).
Pre-epidemic.
Epidemic.
Recrudescence
till 5th April.
Eastern, - - - -
23
54-8
61-8
444
Northern, . . -
22
5-4
7-3
22-8 .
Southern, - . .
17
10-1
14-8
13-5
Central, - - - -
15
22-2
9-6
104
Western, - . .
8
5-7
2-2
4-5
South-Suburban,
8
1-5
3-6
1-6
North-Western,
,7
0-3
0-7
3-4 .
Again it will be observed that the Eastern District alone presents in each of
these periods a proportion of the total attacks much in excess of its proportion of
the total population, while the Central District, into which the disease was intro-
duced, has likewise a larger proportion of cases than of population in the first
period, which, however, is not maintained in the second.
We are, for the moment, endeavouring to obtain some indication of a relation-
ship existing between the volume of infection contained within the Hospital as
distinct from that which may be assumed at ' least to follow in the wake of a
converging stream, both of patients and infected clothing, ])lus the opportunities
for acquiring infection through contact, which the occurrence of a large number of
cases created before their nature was recognised.
If a numerical relationship be established between the cases occurring before
and after the beginning of the year 1901, this, for the City generally, would be
expressed by the proportion of 1 to 3'5. ^
In the Eastern District it was 1 to 3 9, but these formed so large a proportion
of the total that the difference is without importance. In the Northern District,
however, the relationship is as 1 to S'G, while in the South it is 1 to 4-9 ; in other
words, there was almost a fivefold increase here during the epidemic period, as
compared with a fourfold in the Eastern District ; and the cases in the Southern
District occurred at a part which is further removed from Belvidere than any
portion of Bridgeton.
It is impossible to exclude from this the operation of widely distributed
opportunities of infection which we know existed, but a comparison of the pro-
portion of Eastern cases in the several stages of invasion, early activity, decrease,
and subsequent epidemic prevalence of the disease, shows that a general corre-
spondence existed, not so much with the accumulated numbers under treatment, as
with the fluctuations in the number of admissions, although even here the parallel
breaks down when applied to the early period of the epidemic increase.
Proportion of Cases occurring in each District to Total Cases in Several
Periods.
Period Exdisg
Total
cases in
each
period.
Percentage
OF Total Casts.
East.
Central.
North.
South.
West.
S.S.
N.W.
2nd June,
72
25-0
45-S
19-4
2-8
2-8
11th August, -
159
66-7
14-5
6-9
10-1
1-2
0-6
17 th November,
73
53-4
13-7
1-4
23-3
l-i'
4-1
29th December,
93
56-9
18-3
5-4
17-2
] 1
11
9 th February,
550
65-5
6-2
5-1
16-3
M
5-6
0 2
2.3rd February,
127
52-7
15-7
8-7
13 4
1-6
5-5
2-4
23 rd March, -
460
71-2
10-0
6-5
9-2
1 3
1-3
•5
In the period of activity between 2nd June and 11th August, 1900, 67 pei
cent, of the cases were Eastern, the average weekly admissions to Hospital at the
earlier date being 12-5; during the period of autumnal decrease — between 11th
August and 17th November — the proportion of admissions from the Eastern
Division was 53 per cent., while the weekly admissions averaged 5"2 ; 57 per cent,
of the admissions from the middle of November till the close of the year were
Eastern, during which period the average weekly number of admissions was 15'5;
that it rose to 65 per cent, in the four weeks ending 9th February, when the weekly
admissions averaged 138, and to 71 per cent, in the four weeks ending 23rd March,
when the weekly admissions averaged 115.
28
The proportion of Eastern cases during the epidemic period, but especially in
the four weeks ending 23rd March, seems to suggest a definite time relationship
"with the numbers under treatment, which reached their maximum on 8th March,
when there were 522 patients in Hospital, but a comparison of the fortnightly
admissions for the several fortnights of this period does not confirm the impression..
Proportion or Cases occurring in Eastern District to Total Cases registered
IN Several Fortnights, with Maximum and Minimum Number in Hospital.
DURING THE FOURTEEN DaYS PRECEDING EACH PERIOD.
Fortnight ending
Jan. 26. Feb. 9. Feb. 23. Mar. 9. Mar. 23.
73-1 514 52-7 73-2 67-7
106 409 500 485 522
98 96 409 387 394
Here an equal proportion of new cases Avas occurring in the fortnights ending
26th January and 9th March, although the numbers admitted in the fortnight
preceding each {i.e., 12th January and 23rd February) were respectively 23 and
127, while the greatest number in Hospital in each of these last fortnights was 103
and 485, and, in contrast to both, 67'5 of the cases occurring in the fortnight
ending 16th June, 1900, occurred at a time when the number in the wards was 67..
Again, in the following comparison, we find that in Districts 7 and 8 about one-
third of the total cases occurring sickened in the four weeks ending 2nd February,
while the proportion occurring in the four weeks ending 2nd March was little over
a-fourth, although during the weeks of both periods the numbers under treat-
ment in Ho^ital were rapidly increasing. In March again only 16 per cent.-
occurred.
Proportion of Cases admitted from \
Eastern District to total for V
Fortnight, - - - - j
Maximum under treatment during )
previous 14 days, - - - /
Minimum do. do.,
Percentage op Cases occurring during Several Periods op Four Weeks Each:
TO Total Cases sickening in Districts 5, 7, and 8 during Epidemic Period.
Four Weeks
Districts
ending
V.
VII.
VIII.
2nd February,
28
34
32
2nd March,
24
26
26
30th .,
14
16
15
These comparisons have been undertaken with the double object of ascertain-
ing whether Smallpox Hospitals radiate infection in a degree proportioned to
the mass of infection within them, and whether any principles might be deduced
which could guide further policy with regard to Hospital provision.
In the 1870-74 epidemic the disease was propagated in the neighbourhood
of Parliamentary Road Hospital, where Smallpox was then treated.
During the limited outbreaks which occurred from 1892 onwards, we have
found a preponderating proportion of cases invariably contributed by the Eastern, .
29
Districts. In the maps which are appended illustrating the present outbreak,
there is no aggregation of cases beyond the mile and a-quarter radius from the
Hospital which at all corresponds with the evidence of persistent recurrence of the
disease within it.
We have seen that towards the end of May, 1900, cases began to occur in
the immediate neighbourhood of Belvidere, which indicated exposiire to infection
at a date when the cases under treatment barely exceeded 30 daily.
At a later period, increasing numbers in Hospital were associated with
increasing prevalence in its neighboiirhood, yet their proportion to the total
volume on each occasion varied only by a few per cent., while the numbers in
Hospital were multiplied from six to sixteen times.
There is, however, a general correspondence between the proportion of cases
occurring in the neighbourhood of the hospital and the numbers dealt with, but
this is lost during the epidemic period, and the first wave of epidemic prevalence^
early in January, 1901, cannot be brought into any definite relationship with
the numbers in Hospital when it began. It is to be explained rather by
widespread distribution of infection occurring earlier, while with regard to the
subsequent and more restricted increases towards the end of February the
conditions had altered, because in the Eastern District re-vaccination was being
largely resorted to with every recurring wave of prevalence, and the March
increase had, in consequence, a more restricted field for activity. It was, moreover,,
felt elsewhere, as we may see by a comparison of the cases in the Southern District,
during this phase.
It would appear, therefore, to be a not unwarrantable deduction that the
risk of aggregation begins at a very early period, and tends to foster a prevalence
of the disease in the neighbourhood of Smallpox Hospitals ; but that when
epidemic virulence is established, the precise influence exerted by the Hospital
cannot be dissociated from that caused by the independent centres, which it has
in part established.
The investigation throws no light on the channels through which influence
is exercised, except what is of a negative character. The Eastern cases began when
there was no pressure on ward space ; they reappeared at a period of the
recrudescence when this was being specially guarded against ; and but few of the
cases in this period recurred in formerly infected tenements. The topographical
relationship of the Hospital to the surrounding population outside the quarter of
a mile radius does not admit of any discrimination between the effect of aggrega-
tion and the precedent volume of traffic, both in patients and infected clothing,
through the main thoroughfares of the infected district. But a survey of the
whole circumstances leads inevitably to the conclusion that the excessive pre-
valence in the Eastern District has established the unsuitability of Belvidere for
the continued treatment of Smallpox.
In respect to this element of risk to the neighbourhood. Smallpox Hospitals
differ from those for the other infectious diseases. They also dilfer in another
important particular. Since the last epidemic prevalence, in 1870-74, th6 pro-
vision of smallpox accommodation has not been completely taxed until the
present outbreak.
In the present outbreak an interesting feature bearing on this was disclosed.
The incidence of the disease at ages 25-35 was much in excess of that at any other
age period, and indicates that in communities relying solely on infantile vaccination
30
the conditions on which epidemic prevalence depends are re-established by this
period.
In these circumstances, how to meet both contingencies — a recurring epidemic
prevalence at long intervals, and the added risk of concentration present at all times,
but felt most when the pressure is greatest — is the problem which attends all effort
to map out a policy of Smallpox Hospital provision. To maintain several Hospitals
constantly equipped for a remote contingency, however certain may be its
recurrence, would mean waste. A certain minimum accommodation must
always be provided to meet the minor fluctuations of prevalence which, occur
between epidemic periods, but to establish this as the sole centre of aggregation
in epidemic periods results in producing a surrounding mass of infection, which
may be dealt with, but cannot be controlled. To escape the greater risk we
should avoid the concentration, and though, as our experience indicates, a certain
degree attends all aggregations, we might still be able to accomplish in detail
what the combined volume renders impossible.
Relation of Smallpox Incidence to Districts generally presenting
A High Death-rate.
Insanitary conditions are so frequently cited as explaining the excessive
increase of Smallpox in any particular locality that we may enquire whether the
recorded death-rates for the districts chiefly affected afford any support to this.
In the following Table the average general death-rates for six districts
presenting the highest rates during 1898-1900 are stated, together with corre-
sponding rates for Districts 5, 7, and 8, which form the Eastern Division, and the
smallpox attack-rate for each : —
Smallpox Attack-rate and General Death-rate, 1898-1900, compared.
"ni^TRTPT Deaths per 1,000 Smallpox Attack-
from all causes. rate per 1,000.
13. Brownfield, - - . - 33-06 2'5
16. Cowcaddens, - - - - 32-79 1-0
6. High Street and Closes East, - 30-43 2-9
2. Port-Dundas, - - - - 29-55 -3
22. Gorbals, ----- 28-89 1-8
3. High Street and Closes West, - 28-62 -3
Glasgow, - - . - 20-6 2-3
Eastern Division.
7. Greenhead and London Road, - 22-0 9'9
8. Barrowfield, . - - . 25-7 6-4
5. Bellgrove and Dennistoun, - - . 19-0 2-8
There is no suggestion here that the prevalence of insanitary conditions, as
indicated by a continuously high general death-rate, explains the excessive
incidence of Smallpox in Districts 5, 7, and 8.
Again, if we select for further comparison the infantile death-rate, the
Zymotics (excluding Smallpox) and that from Pulmonary Diseases (excluding
Phthisis), in no case is there a parallel to the contrast presented by the death-
rate from Smallpox in these districts.
Death-rate
under 1 year
per 1,000 born.
Death-rate per Million.
District.
Zymotic
Diseases.
Respiratory
Diseases (not
Phthisis).
Smallpox.
13. Brownfield, - - - -
207
5,303
8,934
16. Cowcaddens, - - - -
218
5,033
9,379
220
6. High Street and Closes East,
3,839
5,394
282
2. Port-Dundas, . . .
-4,288
8,150
22. Gorbals, . . - .
209
4,768
7,487
153
3. High Street and Closes West,
177
3,262
6,597
103
City, - - -
153
3,153
4,617
307
7. Greenhead and London Koad,
152
4,319
4,826
1,103
S. Barrowfield, - - - .
180
4,813
6,510
939
5. Bellgrove and Dennistoun,
U2
3,185
4,104
442
33
AGE INCIDENCE OF ATTACKS.
In the following Table the proportion of the population living at several age
periods, together with the proportion of cases and the attack-rate per million
living at each, is stated. No discrimination is here made between vaccinated
and unvaccinated, but the Table shows that at each age period under 20 the
proportion of attacks is smaller than the proportion of population — that 22 per
cent, of the population living under 10 years of age contribute only 5"8 per cent,
of the total cases, while 21 per cent, of the population living between the ages of
15-25 contribute 22'5 per cent., and that 18 per cent, of the population living at
ages 25-35 contribute twice that proportion of the cases. There were almost 5
attacks per 1,000 living between 25-35, so that the susceptibility to Smallpox
at this period of life is considerable.
Table V. — Glasgow. — Proportion of Population and Cases at certain Age
Periods, showing the Number of Cases and the Attack-rate per
Million at each.
Ages.
Proportion
of
Population.
Proportion
of
Cases.
Number
of
Cases.
Attack-rate
per
Million.
0—5
11-9
3-47
61
672
5—10
10-5
2-39
42
526
10—15
9-8
5-91
104
1,393
15—20
lO'l
7-62
134
1,745
20—25
10-9
14-89
262
3,143
25—35
17-5
35-82
630
4,734
35—45
12-4
20-01
352
3,731
45—55
8-6
7-22
127
1,942
55—65
5-2
1-76
31
775
65 and up.
3-1
0-91
16
684
100-00
1,759
Infantile Vaccination.
This contrast in the age incidence may be viewed together with what is
known of the extent to which the requirements of the law in respect to infantile
vaccination are complied with in Glasgow.
34
In several periods tlie proportion of children " not accounted for " in the
vaccination returns is as follows : —
Return of Children "not accounted for" in the Vaccination Returns of
Glasgow Registration Districts in Certain Periods.
Three years, 1879-81, ...
1886-88, ...
Births.
63,661
64,189
Removed from Districts
before Vaccination,
or otherwise not accounted for.
No. Percentage.
1,822 2-9
1,359 2-1
Glasgow. — Return as to Vaccination of Children, compiled from Supplement to the
Monthly and Quarterly Returns of the Registrar-General for Scotland.
1896.
1897.
1898.
1899.
1900.
No.
Per-
centage.
No.
Per-
centage.
No.
Per-
centage.
No.
Per-
centage.
No.
Per-
centage.
Successfully vac-
cinated, -
20,348
84-7
19,932
83-5
20,080
82-8
20,191
83-3
20,512
84-2
Vaccination post-
poned, -
274
M
259
M
256
1-0
215
0-9
162
0-7
Insusceptible of
Vaccination,
214
0-9
212
0-9
184
0-8
201
0-8
196
•8
Died before vac-
cination.
2,546
10-6
2,808
11-7
2,918
12-0
2,865
11-8
2,785
11-4
Removed from
the district, or
otherwise not
accounted for,
650
2-7
668
2-8
825
3-4
775
3-2
703
2-9
Total Births dur-
ing year,
24,032
100-0
23,879
100-0
24,263
100-0
24,247
100-U
24,358
100-0
The reduction in the second period (1886-8) here shown expresses the result
of a systematic efiort on the part of the Sanitary Department to reduce the portion
"not accounted for" in those years. In the individual years 1896-1900 the
tendency towards an increasing proportion again becomes manifest, which
reached a maximum of 3"4 per cent, not accounted for in 1898. The reduction
in the proportion occurring in 1900 is probably the result of the stimulus afforded
by the presence of Smallpox.
We are unable to ascertain the proportion unaccounted for in the several
Sanitary Districts, because no combination of these will quite represent the
Registration Districts, but, in a general way, Bridgeton, Camlachie, and Dennis-
toun enter largely into the Eastern Sanitary Division, and Blythswood and
Milton Registration Districts are respectively Central and Northern. These
are selected because they represent in one case the area where Smallpox was
most prevalent, and in the other where vaccination was most neglected — Black-
friars being unavailable for comparative purposes owing to the presence of the
Maternity Hospital.
35
In the following Table details corresponding to these already given for the-
whole City are given for the Registration Districts for the years 1896-8 : — .
Glasgow. — Births, with Number and Proportion " not accounted for " in
Vaccination Returns.
Births, Not Accounted fob.
1896-8.
Number.
Percentage.
Bridgeton,
5,497
122
2-2
Camlachie,
5,648
110
1-9
Dennistoun,
7,553
161
2-1
Calton, ...
3,495
98
2-8
Blackf riars.
4,179
262
6-3
St. Rollox,
5,386
89
1-7
Blythswood,
2,152
83
3-9
Milton,
4,735
166
3-5
Kelvin, ...
5,453
81
1-5
Anderston,
4,555
95
2-1
Hutchesontown,
8,030
270
3-4
Gorbals,
4,418
116
2-6
Tradeston,
2,398
73
3-0
Kinning Park, ...
1,465
39
2-7
Total,
... 64,964
... 1,765
2-7
Age Distribution in Relation to Vaccination and Fatality.
In the subjoined Table all admissions to Hospital from Smallpox are dealt
with ; the numbers include 61 from neighbouring Local Authorities. The
vaccinated and unvaccinated are distinguished from those in whom vaccination
was said to have been performed, but who presented no discoverable trace of the
operation. One-half of these latter were confluent in type, 11 per cent, were
haemorrhagic. It is very doubtful whether they are entitled to separate classification.
A primary vaccination scar is practically indelible, and any local reaction follow-
ing the performance of the operation of vaccination which does not result in a
cicatrix presenting the well-known characters is scarcely to be regarded as successful.
At every age save those under 10, the fatal attacks of this class equal or exceed
those recovering, but the numbers here dealt with are small, and the percentage
fatality consequently liable to fluctuation. It is probable that the majority are
illustrations of persons in whom the operation was unsuccessful, and that they
should be included in the unvaccinated class : —
36
Table VI. — Glasgow. — Smallpox, 1900-1. — Return as to Vaccination of All Cases teeated in
Belvidere Smallpox Hospital from 1st April, 1900, to 30th June, 1901.
Vaccinated.
Unvaccinated.
Vaccination
Doubtful.
Total.
Age.
©
<a
S-i
0)
.■S a
r-H 4)
a)
,— ■ (U
<B
U
1— < a>
>
o
o
o
o
a>
p
cS O
o n
>
o
o
o
M
Q
c3 o
o 35
g ft
>
O
O
(U
"(5
eg o
1 53
0 — 5 years,
2
1
33-3
18
36
66-6
3
23
37
61-7
5—10 „
31
10
2
16-7
2
43
2
4-4
10—15 „
92
1
1-1
10
4
28-6
1
1
50-0
103
6
5-5
15—20 „
131
4
2
333
1
1
50-0
136
3
2-2
20 — 25 „ ...
242
12
4-7
2
4
66-6
1
2
66-6
245
18
6-8
25—35 „
584
42
6-7
6
5
45-5
4
9
69-2
594
56
8-6
35—45 „
291
51
14-9
8
4
33-3
5
6
54-5
304
61
16-7
45—55 „
91
26
22-2
1
6
85-7
3
4
57-1
95
36
27-5
55—65 „
18
13
41-9
1
1
50-0
19
14
42-4
65 years and over, . . .
10
4
28-6
1
100-0
10
5
33-3
All Ages,
1,492
150
9-1
59
63
51-6
21
25
54-3
1,572
238
13-1
This Table includes Cases from beyond City Boundaries.
Stunmarizing this Table, the broad distinction between tlie fatality of tlie
vaccinated, unvaccinated, and doubtfully vaccinated is tbat at all ages tlie deatb-
rate in vaccinated persons was 9'1 per cent.; in unvaccinated persons, 61'6 per
cent, ; and in persons doubtfully vaccinated, 54' 3 per cent.
Regarding tbe single fatal case occurring in the vaccinated column under
five years of age, it is to be observed that the patient was a boy of two years, with
a fairly abundant discrete rash, whose vaccination mark was '04 of a square inch
in area, was glazed and not foveated, and could not therefore be regarded as
evidence of satisfactory vaccination.
Beyond this, ratio of mortality in the vaccinated class increases until the
age of 65 is reached, and the column of per cent, mortality generally in this class
presents a striking contrast with that at the several age periods in the
unvaccinated class.
Deaths imder Five Years. — A mortality of nearly 62 per cent, of all cases
occurring under five years of age in a population where the proportion of births " not
accounted for " in the vaccination returns average less than 3 per cent, will arrest
attention and requires some elucidation. Of these cases 30 were under one
year : — ■
Glasgow. — Smallpox, 1900-1. — Cases and Deaths under One Year.
Recovered. Died. Total.
Under 1 Month, ... 2 8 10
„ 2 Months 2 1 3
„ 3 „ _ 1 1
„ 4 „ 2 4 6
„ 5 , — 1 1
„ 6 „ _ 1 1
12 „ 1 7 8
7 23 .30
37
All these were Tinvaccinated prior to contracting the disease, and we shall
clearly appreciate the significance of this by considering the age incidence more
in detail. For this purpose I have selected two periods with which to compare
the present age incidence of smallpox deaths, viz., 1855-57, being the early
years of death registration (and during two of which Smallpox was prevalent),
and 1870-72, when it was also present in epidemic form.
Table VII. — Glasgow. — Smallpox. — Deaths at Certain Age Periods in 1855-57,
1870-72, and 1900-01, showing the Proportion of Total Deaths at Each Age.
Ages.
Deaths.
Peecentage of
Total
Deaths.
loOt>-/.
1900-01.
loDo
-5 / .
1870-72.
1900-01.
Under 3 months,
47
24
1 n
iU
6-4
0 1
4-2
,, b ,,
40
32
a
D
5-5
o y
2-5
„ 1 year,
161
16
/
22-1
4 0
3-0
,, 2 years, ...
1 "79
o
ZO 0
1-4^
„ 3 „
104
5
14-3
1'4
>50-5
' 6-4
5-9
„ 4 „
53
4
7-3
1-1
,, 5 ,,
O iJ
Q
5-3,
2-5.
„ iU ,,
31
43
2
4-3
120
0-8
„ 15 „
10
31
6
l-4\
8-7'
2-5^
„ 20 „
15
27
3
2-0
7-6
1-3
„ 25 „
31
59
18
4-3
16-5
7-6
„ 35 „
17
66
56
2 3
18-4
23-5
|61-5
183-6
„ 45 „
6
23
61
0-8
6-4
25-6
„ 55 „
3
8
36
0-4
2'2
15-1
„ 65 „
5
14
0-0
1-4
5-9
65 years and over,
1
5
o-o/
0-3|
2-lj
All Ages, ...
729
358
238*
100-0
100-0
100-0
* Includes Deaths in Hospital of Patients from beyond City Boundaries.
The broad distinction presented in these Tables has often been pointed out,
and may thus be summarised for the three periods : —
Proportion of Deaths. 1855-57. 1870-72. 1900-1.
Under 10, 88-8 38-5 16-4
Over 10, 11-2 61-5 83-4
In the two periods of life here contrasted the proportion of deaths under and
over 10 years of age becomes almost exactly reversed. But the Tables are
38
interesting from anotlier aspect. In tlie first two periods compared, a notable
reduction occurs in tlie proportion of deaths occurring under 5 years of age,
but between 5 and 10 the proportion in the 1870-72 outbreak increases just as do
those at later ages. Indeed the contrast presented is rather as between ages
under and over 5 years, and no less than 12 per cent, of the deaths in 1870-72
were at ages 5-10. At this period of life during the present outbreak less than
1 per cent, of the deaths occurred, and the increase which is so marked in
1870-72 is obviously the result of a large number of susceptible children
existing in the population from among those born in the years preceding the
commencement of the Vaccination Act in Scotland in 1864. Along with this,
it Avill be noted that the six months which elapse between the birth and vaccina-
tion of a child in Scotland is reflected in the still large proportion of deaths
occurring in the early months of infancy.
Re-vaccination.
The Health Committee early recognised the necessity for special effort being
made to accomplish re- vaccination of the population, and on 11th June, 1900, the
following circular was issued, with their approval, to medical practitioners : —
11th June, 1900.
Dear Sie,
SMALLPOX— RE-Y A CCINATION.
Public Health (Scotland) Act, 1897, Sec 77.
In view of the present distribution of Smallpox in Glasgow, the
Corporation (Police Department), as Local Authority, desire to impress on the com-
munity the extreme desirability of each of its members acquiring the complete pro-
tection from the disease which recent successful re-vacoination affords. They are also
desirous of affording to every inhabitant who may wish to be re-vaccinated, but who
cannot afford to pay for the operation, facilities for having it done. They have resolved
to exercise the power conferred upon them by the 77th Section of the Public Health
(Scotland) Act, and are prepared to pay to practitioners who re-vaccinate such persons
a fee of Is. 6d. for each successful vaccination. The Corporation believe that if by
any means they could obtain the re-vaccination of every individual in Glasgow above
ten years of age, and the primary vaccination of all who had never been vaccinated, an
epidemic prevalence of Smallpox would be impossible within their jurisdiction.
The conditions of payment of this fee are these —
1. It is not in addition to, but in place of, any private fee.
2.. The name, age, address in full, and result in each case must be returned to me
every Saturday, on forms to be supplied, the postage of which will be repaid.
3. The sums due will be made up from these lists, and paid at the same time and
in the same way as fees under the Infectious Diseases (Notification) Act,
viz., in June and December.
The Corporation rely upon your active co-operation in urging all persons within
the scope of these conditions over whom you have influence to take advantage of this
opportunity of putting themselves beyond the reach of Smallpox.
I am,
Yours truly.
A. K. CHALMERS,
Medical Officer of Health.
39
Special representation was also made to every employer of labour among
whose workers any case of the disease was recognised, and the Tramways Committee,
through their General Manager, set an excellent exainple duriag this month in
procuring the re-vaccination of all their employees. But with the diminishing
number of fresh cases as the summer advanced, interest in the question was
practically confined to the immediate neighbourhood of the cases, and to the
factories where they were employed. This is best illustrated by contrasting the
number of persons re-vaccinated at their own residences — in and around infected
tenements — with the number of those availing themselves of the offer through
medical practitioners, as given in the following«Table : —
Summary op the Vaccinations and Re-vaccinations done by the Officers of the
Sanitary Department and by Practitioners during 1900.
Primary. Secondary.
At Office, 550 264
At Hospitals, 7 205
At Residence, by Staff of Department, ... ... 5 6,372
By Practitioners, in terms of circular of 11th June, 8 964
In Prisons, ... ... ... ... ... — 196
Total, 570 8,001
When the rapid increase in the number of admissions to Hospital during
January, 1902, gave ample evidence that the outbreak was assuming proportions
quite unknown locally in recent years, a second circular to practitioners was issued,
which differed in two important particulars from the earlier one. It reduced the
age limit for re-vaccinations to five years because of the number of children admitted
with trifling vaccination cicatrices, and withdrew the stipulation regarding the
inability of the person desiring re-vaccination to pay a fee for the operation.
This circular was in the following terms : —
Sanitary Department, 23 Montrose Street,
Glasgow, 24th January, 1901.
CIRCULAR LETTER TO PRACTITIONERS.
Smallpox — Re-v^ccination.
Dear Sir,
In June last the Health Committee issued a circular to prac-
titioners inviting them to urge the desirability of re-vaccination on all with whom they
had influence. The response to this was extremely disappointing, lai'gely because of
indifference to re-vaccination, resulting probably from the limited number of the cases
of Smallpox occurring at that time. The circumstances are now much altered.
Smallpox has assumed alanning proportions. Already the number of cases occur-
ring daily exceeds anything which the City has experienced since 1873, and although
at the present moment the greatest prevalence is in Parkhead, Biidgeton, Dalmarnock,
and the Eastern Districts of the City generally, there are indications that other districts,
notably Gorbals, Govanhill, and Anderston, are on the eve of a similar expansion of the
disease. Nothing, save a general recourse to re-vaccination, will prevent its spread
throughout the City generally.
In the circumstances the Health Committee would again invite your active co-
operation in urging re-vaccination. They are thoroughly convinced that if every con-
sulting room became an active re-vaccinating centre many lives would be saved, the
virulence of the present outbreak would rapidly become moderated, and an invaluable
service be rendered alike to the Corporation and the community.
40
The Committee are therefore prepared to pay for the successful re-vaccination of
any person over five years of age a sum of Is. 6d., under the following conditions: —
1. The name, age, address in full, and result in each case must be returned to me
every Saturday, on forms to be supplied, the postage of which will be repaid.
2. The sums due will be made up from these lists, and paid at the same time and
in the same way as fees under the Infectious Diseases (Notification) Act^
viz., in June and December.
3. Lymph will be supplied on application (personally or by messenger) at the
Sanitary Office.
As many of the cases occurring among imperfectly vaccinated persons are of a
mild and modified type, the recog-nifeion of Smallpox is apt to be extremely difficult,
and this is enhanced by the fact that it is in these cases that the various prodromal
eruptions are apt to appear. These eruptions bear no resemblance to the true variolar
eruption, but, on the contrary, may closely simulate typhus fever, scarlet fever, or
measles.
With the object of facilitating the recognition of such cases, I append the following
note.
I am, Deae Sir,
Yours truly,
A. K. CHALMERS.
N.B. — Efficient vaccination is only to be obtained when the total area of vesiculation
produced is not less than half a square inch in size on the eighth day, and a similar
result should be aimed at in re-vaccination.
A. K. C.
Appendix.
Prodromal eruptions, which are apt to be veiy puzzling, may assume the foUowing^
forms : —
1. The most common is general erythema, closely resembling the rash of scai-let
fever, affecting chiefly the trunk, but passing later to the extremities. Thisi
eruption may persist after the true papular eruption has been out for a day
or two.
2. A coarsely punctate erythema, sometimes becoming petechial, appears on the groin
and sides of the abdomen. It is generally confined to a triangular area,
bounded above by an imaginary line crossing the abdomen transversely a
little below the umbilicus, and bounded laterally by, lines passing from the
iliac crests to an imaginary point about four inches below the pubes.
3. A dusky brown tint, not very obvious, and fading on pressure, generally over lower
part of trunk, especially in lumbar and sacral regions.
4. A morbilliform eruption, closely resembling a measles or typhus rash, appears in
ill-defined patches on the trunk.
HEMORRHAGIC SmaLLPOX.
In this form the symptoms of invasion are very severe. The face and limbs may
remain perfectly normal in appearance. There is, in the complete form, no papular
eruption at all ; in less marked forms, the papular eruption is very scanty and irregularly
developed. It begins with a well-marked erythema on the trunk, especially over the
lower part of abdomen. This rapidly extends and becomes livid in tmt, and may finally
involve the whole trunk. Petechite, of variable size, soon make their appearance, in
addition to the general staining.
Blood may be voided by all the mucous surfaces, and the ocular conjunctiva may
become black owing to haemorrhage.
Early in the disease the eruption may be mistaken for that of typhus.
N.B. — It is of the greatest importance that every anomalous rash or suspicious cases
of illness should be at once intimated to the Medical Officer of Health.
41
The immediate result of these was to convert the consulting rooms of practi-
tioners in infected districts into vaccination stations, where the work of re-vaccination
went on frequently for hours daily. This activity continued untii-the second wave
of prevalence in the beginning of February had subsided ; but in the report for
the fortnight ending 23rd February I had occasion to observe " that, while the re-
vaccinations reported during the fortnight numbered 77,652, as against 36,812 in the
previous one, the quantity of lymph issued during the past week by the Department
to practitioners has shrunk to such an extent that the amount of active re-vaccina-
tion now going on in the community must be very far short of that done during
previous weeks. This is much to be regretted, because the seasonal conditions
which favour the spread of Smallpox reach their acme in the spring months, and
the approach of this period must be regarded with some apprehension if the apathy
regarding vaccination, which is again becoming manifest, continues." It is possible
that the resolution of the Special Committee appointed to deal with the epidemic,
to cease publishing the number of fresh cases occurring daily at this time, helped,
in part, to confirm the impression created by the diminishing numbers ; but it has
been a frequently repeated experience of the Department that the number of
re -vaccinations which it is possible to obtain rise and fall with the number of cases
of Smallpox occurring, and that prudential motives are apt to remain in abeyance
unless stimulated by present risk.
The recurring increase in the number of admissions to Hospital early in March
led to the adoption of a system of house-to-house visitation in certain districts, on
the lines indicated in the annexed circular : —
Sanitary Chambers, 23 Montrose Street,
Glasgow, 7th March, 1901.
CIRCULAR LETTER TO MEDICAL PRACTITIONERS.
Dear Sir,
Smallpox — Re-vaccixation.
The Executive Committee gratefully recognise the response recently
made by practitioners to my circular of 28th January last inviting them to /perform
re- vaccination on any who chose to avail themselves of the offer then made. They feel,
however, that further effort is required to reach those who are indifferent to the present risk,
and that this can best be secured by a systematic visitation from house to house in certain
districts of the City, and they desire me to invite your co-operation in this work.
Such a scheme would be based on the Census Enumeration Districts. These districts
vary in size, but on an average each contains about 1 50 houses, distributed over from 1 2
to 15 tenements. This number might readily be covered within a week by taking two
tenements each evening, which is the only time when the majority of the inmates are
likely to be found at home.
The Committee feel assured that they can with confidence rely on tlie co-operation
of the medical profession in this further effort to secure the re-vaccination of the
remaining portion of the population, and a post-card is enclosed, which I have to ask
you to be good enough to forward me by return post, stating whetlier you can find time
to devote to the work. For each vaccination so obtained a fee of 2s. 6d. will be allowed.
Yours truly,
A. K. CHALMERS.
42
While the medical practitioners were thus invited to take up district visitation
on these lines, the officers of the Department were aided in the work of vaccination
by a special corps, ultimately numbering 484, and composed of 254 students of
medicine, and 230 others, chiefly drawn from other departments of the Corporation
service, and working under the direction of Dr. Carmichael, Vaccinator to the Depart-
ment. The energies of this corps were directed, in the first place, to the neighbour-
hood of those streets where Smallpox was occurring, but as soon as possible they were
distributed over the Census enumeration areas. It also became possible to take a
census of the condition of these districts in respect to vaccination, the returns,
however, being based wholly on the verbal statement of the person in charge of
the household at the time of the visit.
It is, unfortunately, impossible to state with any degree of accuracy the extent
to which re-vaccination had been carried at this period in the community generally,,
because information on this point would supply the answer to the question whether
any considerable section of a community exposed to a known risk, and with every
facility offered of protection against it, are so completely indifferent to both that
the means of protection must be brought to them before they will avail themselves
of it. When the house-to-house visitation began in March, the census appeared ta
indicate that 53 per cent, of the population over five years had been recently re-
vaccinated. This would represent 355,570 persons on whom the operation had
already been performed, which, however, is in excess of the total for which payment
was made by the Corporation during the whole outbreak, and is only 49,695 less
than is shown by the completed returns of the year. Together with those obtained
in 1900, this gives a total of 405,265, and would appear to indicate that house-to-
house visitation, directly and indirectly, resulted in procuring an addition of over
49,000 from those who had previously proved indifferent.
Till the close of the fortnight ending March 9th, over 157,000 re-vaccinations
had been recorded, as shown in the following Table, but this represents only 23 per
cent, of the population over five years of age. Of these, 146,000 had been done by
practitioners, but the dates on which the returns were received were not closely
related to the fortnights in which the vaccinations had been performed, and, even
when all had been returned, the information afforded did not readily lend itself to a
detailed tabulation of the numbers performed in successive weeks.
It, is probable, therefore, that the estimate of 53 per cent, is in excess of the
proportion already re-vaccinated by the beginning of March, and the annexed Table,
showing the number of tubes of calf lymph issued by the Department to medical
practitioners fairly reflects the ebb and flow of the demand for re-vaccination in the
various districts : —
43
Table op Tubes of Glycerixated Calf Lymph issued to Practitiosers.
Date.
January.
February.
March.
April.
1
4,557
440
232
0
670
755
120
3
170
130
4
3,104
1,664
140
5
3,849
2,295
145
6
3,006
2,319
120
7
3,009
3,359
8
3,799
4,047
80
9
2,789
1,925
130
10
100
70
11
2,007
2,499
105
12
2,204
3,066
155
13
1,292
1,860
40
14
895
2,489
5
15
998
2,600
35
16
594
2,255
10
17
30
18
436
1,516
10
19
609
1,962
20
439
1,064
30
21
383
880
22
164
45
23
280
847
11
24
' 80
25
400
550
26
355
330
27
2,776
599
220
^0
0 9 in
ooo
-1 1 O
9n
^yj
29
4,055
140
15
30
4,707
200
28
31
4,363
18,141
37,143
39,737
1,706
Average Daily Issue — February, 1,326; March, 1,281.
44
Summary of the Vaccinations and Re-vaccinations done by the Officers op the
SaiVTTATJV 'D'PP a PTAT'n''NrT ATCn TIV "Pr? APTTTTONF.TJS
KJ AIN i 1 AJK. I J-/ Jjjr^2i.IV -L iVlJCjPl i- AlAi-f 13 1. J_ J.V X 1 X 1. V/il l-iitO
DURING
1901.
Primary.
Secondary.
At Office,
^ 433
486 ■
In HosDitals, ...
11
556
At Residence, by Staff of Department,
_
14,763
In Prisons and Poorhouses, ...
24
11,293
By Practitioners, in terms of circular letter of 24th
January, 1901,
—
283,423
j3y Special Vaccinators working in Enumeration
Districts, ...
—
29,081
By Practitioners in Enumeration Districts, in terms
of circular letter of 7th March, 1901, ...
—
12,424
468
352,026
In reply to a circular letter, 447 Practitionei'S
intimated that, in addition to those done for the
Corporation, they had done private re-vaccina-
tions numbering ...
45,238
Total re-vaccinations, ...
397,264
Add for 1900, ...
8,001
Add for 1902 to 3rd May,
7,972
413,237
Re-vaccination in Relation to Attack.
In 126 cases admitted it was found that re-vaccination had recently been
performed, and the following figures, taken from a Table compiled by Professor
R. S. Thomson, Visiting Physician to the Smallpox Hospital, and Dr. Fullarton,
Resident Physician, show the number of days intervening between the successful
performance of the operation and the development of symptoms of Smallpox : —
Number of Days before Sickening —
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Number of Cases —
6 11 3 7 20 17 6 11 13 4 1 — 1 1
If we assume that twelve days represents the average period of incubation,
then the chances of escape are still very considerable, although the re-vaccination
may be postponed until the third day after exposure. In a small number of cases
re-vaccination had been performed successfully before the attack occurred, but
these are at intervals of years, and the following Table, also prepared by Drs.
Thomson and Fullarton, shows the interval between re-vaccination and attack, and
the character of the latter : —
45
Table showing, in Cases successfully re-vaccinated before Infection, the
Period between Re-vaccination and Attack and the Influence of Re-
vaccination ON Severity of Attack.*
Case. Primary Vaccination. Date of Re- vaccination. Character of Attack.
H. B.
aged
25
1
mark-
—poor
6
years ago
Very sparse.
Mrs. M'L.
J'
43
1
11
fair
11
Sparse.
G. C.
jj
44
1
l;
poor
21
11
Very sparse.
W. W.
))
37
1
11
poor
27
11
Fairly abundant.
J.K.
)j
48
1
11
poor
28
11
Very sparse.
J. R.
II
43
3
M
poor
31
11
Sparse.
P. M'L.
))
42
2
11
fair
32
11
Very sparse.
A. S.
11
28
1
11
fair
(?) 4
1'
Fairly abundant.
Statement as to Vaccination op Cases admitted to Hospital during Period of
Recrudescence, 1901-1902.
Age.
Total.
Vaccinated.
Un vaccinated.
Doubtful.
Under 5 years, ...
6
15
3
5—10 „ ...
4
2
2
10—15 „
8
2
1
15—20 „
22
20—25 .,
60
3
2
25—35 .,
155
3
2
35—45 „
124
1
1
45—55 „
32
1
3
55—65
9
1
65 and upwards,
4
All ages, ...
424
27
15
The widespread distributiou of the infection, and the extent to which
re-vaccination was resorted to, afforded an opportunity of observing the behaviour
of the disease in one section of the population which, in the course of the outbreak,
gradually increased until it comprised almost 60 per cent, of the whole. This
section comprised those persons who were successfully re-vaccinated before they
were exposed to infection between January, 1901, and May, 1902. It may be
represented as increasing by fortnightly drafts obtained from the section who were
not re-vaccinated, as is shown in the following Table (p. 46).
In respect of susceptibility and the opportunities of exposure to infection,
there is nothing to distinguish between these two sections here shown save the
solitary circumstance of successful re-vaccination, and the contrast presented by the
uniform absence of cases from the re-vaccinated section requires no elaboration.
* During the period of recrudescence 11 cases were admitted with a history of siiccessful re- vaccina-
tion before infection, and in 10 of these the statement of the patient was supported by the presence of
distinguishable marks. The intervals elapsing between re-vaccinatfon and attack were resoectively
3, 3, 4, 7, 8, 9, 12, 26, 32, 40, and 55 years.
■i6
Table YIII. — Glasgow. — Smallpox, 1901-1902. — Un-revaccinated and Re-vaccinated
Population in each Fortnight, with the Cases of Smallpox occurring in
EACH Class.
1901.
Not Recently Re-vacoinated.
Recently Re-vaccinated.
Population.
Cases
Registered.*
Population.
Gases
Registered.
January
12th,
675,887
26th,
4,81o
1,0 / 1
February
9th,
671,025
•1 A.I
202
A O J?
4,862
23rd,
oo4,213
i21
A 1 £*f7 A
4l,o74
March
9 th,
556,561
23rd,
518,426
lol
157,461
April
6th,
474,Da4
y J
OAT 1 OQ
n
20th,
429, OOD
d7
24D,o3i
May
4th,
384,371
28
291,516
51
18th,
366,125
T O
18
309,762
June
1st,
352 633
t/ w J \j tj
11
323,254
5)
15th,
2
328,110
29th,
Q
O
July
13th,
1
3y4,020
November 1 6th, ...
1
))
30th,
279,232
5
39 b,bo5
December 14th, ...
279,020
4
39b, 867
28th,
278,796
397,091
1902.
J anuary
11th,
278,623
28
397,264
25th,
278,152
23
397,735
February
8th,
277,653
23
398,234
))
22nd,
277,134
147
398,753
March
8th,
276,033
92
399,854
)>
22nd,
274,611
85
401,276
April
5th,
272,694
36
403,193
))
19th,
271,619
15
404,268
May
3rd,
27L032
10
404,855
* The Cases under five years have not been excluded from these figures, because their allocation
through the various fortnights would have been difficult, and their inclusion is unimportant. In the
1900-1901 part of the outbreak these numbered 60, 54 of whom (including 30 cases occurring under
one year) were unvaccinated primarily.
47
Expenditure on Re-vaccination.
From 1st June, 1900, till 1st March, 1902, the amount expended in connection
with re-vaccination was as follows : —
Calf Lymph, £4,570
Fees to Practitioners, 22,776
Do. Extra Vaccination Staff, &c., ... ... ... 4,177
Do. Prison and Parish Surgeons, ... ... ... 713
Total, £32,236
49
CHARTS OF SICKENING.
These charts have been constructed after careful enquiry into the dates of
sickening of the cases occurring during the epidemic period and'^during the whole
period of recrudescence. The interval of declining prevalence which occurred in
the middle of the epidemic period is shown by a depression beginning on the 1st
and extending to 19th February.
The secondary wave of prevalence, which reached its acme on 1st February,
is obviously definitely related to the earlier prevalence of 17th January, but the
recurring increases, which began on 19th February, and reached their maximum
on 2nd March, have a less tangible relationship with the amount of infection
which was distribiited by the cases sickening about 1st February.
The rapid recurrence, also, of the elevations of 26th February and 2nd
March are in striking contrast with the uniform rise and fall of the waves of l7th
January and 1st February. They suggest the difference between a source of
infection in somewhat continuous operation and one in which the discharge is
periodic. The disti'ibution in these later prevalences was pretty general, and
the following contrast between the proportions in corresponding fortnights in the
Eastern and Southern Districts is important in this respect that the Southern
District is beyond Hospital influence, and yet a recurring prevalence late in
February was also apparent there: —
Proportion of Total Attacks in Eastern and Southern Districts occurring
IN Several Fortnights of the Epidemic Period.
Eastern Cases, 863. Southern Cases. 200.
26th January, = 29-7 per cent. = 26-0 per cent.
9th February, = 12-1 ., = 18-5 „
23rd „ = 7-8 „ = 8-5
9th March, = 254 „ = 13-0
23rd „ = 12-6 ., = 8-0 „
MAPS.
Little need be added by way of a special description of the accompanying
maps, I. to YII. In them the administrative divisions of the City are contained
within the thick, and the sub-districts within the thin red lines. The former
are referred to in the text as Eastern, Central, Western, Northern, North-
Western, Southern, and South-Suburban ; while the sub-districts are numbered
consecutively, a few being distinguished by letters. Save where otherwise
stated, the maps are constructed on the number of cases registered fortnightly,
but some exceptions occur where the arrangement is according to periods of
sickening. Where it was wished to distinguish between the areas involved in
successive fortnights a distinguishing colour has been used. The situation of the
Hospital is indicated by a red cross, and the circles surrounding it are drawn with
radii respectively of \ mile, \ mile, 1 mile, and 11 miles.
In Map 1. it will be seen that during the early weeks of the invasion of the
disease the direction in which dissociated cases tended to spread was northerly,
whereas in the fortnights ending 2nd, 16th, and 30th June there was a quite
definite distribution of cases in the Eastern Division (see Map IL).
In the several fortnights shown on this map the sicknesses occurred on the
following dates, and it may be observed regarding the sicknesses occurring
towards the end of May that the wind was continuously from the east between
the 7th and 13th of the month, south-east on the 6th, and north-east on the 14th.
50
On all the other days, save tlie last two, tlie direction varied to the north or south
of west. From 30th May to 4th June the wind was east.
Record
OF Daily
SiCKENINGS IN EASTERN DISTRICT—
May and
June, 1900.
Fortnight
ending
2nd June.
Number
Sickening.
ending
16th June.
Number
.^1 pIt pm n cr
Fortnight
ending
30th June.
Number
24th May, -
2
3rd June,
-
17th June,
3
25th „
4th „
2
18th
2
26th „
5th .,
19th
Ji
1
27th „ -
1
6th „
1
20th
3
2c5th „
7th „
21st
2
29th „
2
8th „
4
22nd
2
30th „
3
9th „
2
23rd
?)
4
31st ,,
4
10th „
- -4
24th
1
1st June, -
2
nth „
3
25th
4
2nd ,,
2
12th „
3
26th
!J
13th „
5
27th
3J
14th „
3
28th
) J
15th „
2
29th
16th „
30th
)J
16 29 22
During the weeks of July and August cases were recorded in the situations
already indicated in Map IL, but also extending eastwards from Parkhead Cross
along Westmuir Street and Great Eastern Road.
Map III. shows the cases recorded in the fortnights ending 1st, 15th, and
29th December, 1900, and 12th January, 1901, and in respect of numbers affords
a striking contrast with those occurring in the following fortnight, shown in Map IV.
In Map V. the distribution of the cases forming the major part of the second
rise, culminating on March 2nd, are shown ; and if any distinction is to be drawn
between this and that shown on Map IV., it might be said that, while in the
earlier period the cases in the Eastern District tend to aggregation along main
lines of traffic, the distribution in the second fortnight is more uniformly spread
over the intervals between these lines.
Map VI. covers the whole period of recrudescence until 1st May, 1902. The
distribution of the earlier cases between November and February is indicated by
blue dots, and one of the most striking episodes in the recurrence is shown on
Map VII., when in the fortnight ending 22nd February the whole character of
the recrudescence became altered, and we had repeated, on lines very similar to
those of the major outbreak, an epidemic activity which in numbers amounted to
quite one-third of the volume occurring in corresponding months of 1901.
Some reference has already been made to the prevailing meteorological
conditions in May, 1900, and more complete details will be found in Appendices.
The annexed summaries of the conditions prevailing during several months when
the disease was most active are also by Professor Becker. It may be observed
with regard to the increased prevalence late in February, 1901, that on the 2nd
and 13th only was the wind easterly, while the increase began on the 19th.
A. K. CHALMERS, M.D.
Sanitary Chambers,
Glasgow, May, 1902.
51
APPENDICES.
Meteorological Observations taken at Glasgow Observatory
DURING May, 1900.
Day of
the
Month.
Humidity
per cent.
MiDXIGH"
Wind.
r TO jMidnight.
Rain.
Remarks.
9 a.m.
9 p.m.
Genercil
Direction.
Inches.
Hours.
1
60
71
W.
•01
1
Slight rain in morning. Solar halo at
7 p.m. Cloudy and dull.
84
75
s.w.
•08
5
Heavy rain in morning. Cloudy and
fine.
3
76
80
s.w.
•21
14
Cloudy and heavy showers.
4
83
74
s.
■20
5
Heavy rain in morning. Overcast
and squally.
5
88
70
s.
■07
6
Rain in morning. Cloudy and fine.
6
63
93
S.E.
•20
7
Morning cloudy. Rain afternoon and
evening.
7
93
86
E.
•18
10
Rain in morning. Dull. Evening
cloudy.
8
73
81
E.
•02
2
Cloudy. Slight rain in evening.
9
69
79
E.
•13
5
Heavy rain in morning. Cloudy.
Evening dull.
10
72
74
E.
Cloudy and dull.
11
74
74
E.
Generally overcast.
12
76
72
E.
•09
8
Rain in morning. Cloudy and dull.
13
62
74
E.
Cloudy and dull.
14
58
75
N.E.
Cloudy and fine.
15
60
69
W.
Clear and fine.
16
49
70
N.W.
Clear and fine.
17
63
69
N.W.
Cloudy and fine.
18
Ot
0 J
N.
Cloudy and dull.
19
65
74
W.
Cloudy and fine.
20
62
75
w.
Cloudy and dull.
21
83
94
•42
10
Overcast and rain.
22
77
83
s.w.
•17
12
Cloudy and heavy , showers.
23
85
89
s.w.
•07
3
Rain morning and afternoon. Cloudy.
24
59
78
w.
Cloudy and fine.
25
68
87
w.
•01
1
Slight rain in morning. Cloudy.
26
72
79
s.w.
•03
4
Cloudy and dull. Rain in evening.
27
81
92
s.w.
•25
13
Overcast and rain.
28
84
80
w.
■02
3
Rain in morning. Squally. Dull
29
66
and cloudy.
73
N.W.
Clear and fine.
30
66
74
E.
Clear and fine. Evening dull.
31
77
80
E.
Dull and overcast.
52
Meteorological Observations taken at Glasgow Observatory
DURING June, 1900.
Day
of the
Month.
Humidity
per cent.
MiDNiaHT TO Midnight.
Wind.
Rain.
Remarks.
9 a.m.
9 p.m.
General
Direction.
Inches.
Hours.
1
2
79
80
83
73
E.
E.
Morning and evening dull. Afternoon
clear.
Morning dull. Clear and fine.
3
68
63
E.
Clear and fine.
4
72
87
E.
Clear and fine. Evening cloudy.
5
88
79
N.E.
Cloudy and dull.
6
79
87
KE.
Cloudy and dull.
7
8
86
85
91
81
E.
E.
•18
•01
6
2
Rain morning and afternoon. Cloudy,
thunder and lightning at 3.30 p.m.
Dull, and evening cloudy.
9
94
86
S.
•14
6
Overcast. Drizzling rain.
10
66
74
S.
Cloudy and dull.
11
12
13
14
71
80
86
77
83
92
90
75
w.
E.
E.
s.w. _
•02
•14
•51
1
7
12
Cloudy. Shower about 7.20 p.m.
Thunder at 8 p.m.
Thunderstorm and rain morning and
{^"STt^Yi in rr 1 In 1 1
xj V t;±iiJLl^. .1 J LLIi.
Cloudy. Thunderstorm morning and
afternoon. Heavy rain.
Cloudy and fine.
15
63
87
S.E.
Cloudy and dull.
16
74
89
w.
•18
3
Cloudy. Rain at night.
17
75
76
w.
•08
9
Rain in morning. Clear and fine.
18
69
78
s.w.
Cloudy. Evening dull.
19
20
21
22 -
23
87
86
71
69
65
77
85
91
82
73
s.
s.w.
w.
w.
w.
■29
•40
•39
•23
8
9
4
Rain morning and afternoon. Over-
cast.
Heavy rain in morning. Thunder in
afternoon. Slight rain at 10 p.m.
Cloudy and dull. Heavy rain and
thunder in afternoon.
Rain in morning. Thunder at noon.
Cloudy.
Clear and fine.
24
81
95
E.
1^36
16
Overcast and heavy rain.
25
68
M
81
N.E.
■04
3
Rain in morning. Cloudy and dull.
26
68
84
N.W.
Overcast. Evening cloudy.
27
71
77
W.
Cloudy and fine.
28
29
59
73
74
95
S.W.
s.w.
•01
•16
1
10
Morning fine. Dull. Slight rain at
night.
Rain morning and evening. Overcast.
30
85
94
w.
•20
8
Cloudy. Rain at night.
53
Meteorological Observations taken at Glasgow Observatory from
26th December, 1900, to 31st January, 1901.^
Day of
the
Month.
Humidity
per cent.
Midnight to Midnight.
Wind.
Rain.
9 a.m.
9 p.m.
General
Direction.
Inches.
Honrs.
oa
Zo
o4
88
s.w.
•m
1
z7
QK
yo
85
£j.
OO
la
28
DO
-IN . w .
n
1
29
85
88
W .
■06
2
Q A
oU
yo
82
E.
01
1 /
Q 1
ol
OD
81
N.E.
Jan.
1
86
90
ft. W .
•13
7
9
94
S.W.
uo
A
Q
o
a o
86
to. W .
4
yo
79
ft. vV.
5
OD
82
b.hi.
o
73
69
Hi.
n
1
82
84
E.
Q
o
89
85
E.
•07*
5
Ci
y
OO
82
E.
10
yb
93
E.
UO
Q
0
11
96
91
Til
hi.
•12
6
12
92
89
E.
1 o
85
79
E.
1 A
81
66
Jsr.E.
15
74
68
N.E.
16
79
91
KE.
17
91
85
S.W.
•01
5
18
92
93
S.W.
•13
5
19
96
92
N.E.
•39
11
20
81
82
W.
•13
10
21
87
84
w.
•02
3
22
95
81
w.
•13
10
23
83
77
S.W.
24
93
91
S.W.
•10
8
J,0
83
77
w.
•41*
12
26
78
98
w.
•26*
12
27
67
93
N.W.
•30
18
28
100
86
w.
•17t
5
29
90
75
N.W.
•Olt
5
30
73
73
N.W.
31
72
72
N.W.
Remarks.
Dull and cloudy.
Overcast and rain.
Rain morning and afternoon. Squally.
Slight showers in morning. Fine.
Haze and sleet at night.
Overcast and rain. Cloudy at night.
Dull and overcast.
Cloudy and showery.
Rain in morning. Cloudy. Fog at
night.
Dull and hazy.
Dull and overcast.
Cloudy and dull. Hazy at night.
Hoar frost in morning. Cloudy and
dull.
Dull and overcast.
Dull and overcast. Snow in forenoon.
Cloudy and misty. Hoar frost at night.
Overcast. Rain in afternoon.
Dull and hazy. Rain afternoon and
evening.
Cloudy and hazy.
Dull and overcast.
Cloudy and hazy.
Cloudy and hazy in morning. After-
noon and evening clear.
Cloudy and dull.
Slight rain in morning. Cloudy.
Rain morning and afternoon. Cloudy.
Overcast and rain. Evening cloudy.
Overcast, squally and showery.
Overcast and rain in forenoon. Cloudy
and squally in evening.
Squally and rain morning and after-
noon. Evening cloudv.
Dull.
Dull and showery. Squally in evening.
Rain in morning. Squally and cloudy.
Showers of snow.
Snow, 2^ inches deep, in morning.
Dull. Rain in afternoon and evening
Squally, cloudy, showers of hail, rain,
and snow.
Cloudy, and snow showers, 2| inches
deep. Lunar corona at 6 p.m.
Cloudy and dull.
Cloudy and dull. Lunar halo and
corona at 7.30 p.m.
Clear and fine. Lunar corona at 9.15
p.m., and halo at 10.30 p.m.
Rain and Melted Snow.
t Melted Snow.
54
Meteorological Observations taken at Glasgow Observatory
DURING February, 1901.
Day of
the
J.TXUU Lll*
Humidity
per cent.
MiDNIGHl
Wind.
TO Midnight.
Rain.
Remakks.
9 a.m.
9 p.m.
General
Inches.
Hours.
1
78
96
W.
•05
5
Dull. Rain in afternoon.
2
O i
80
ou
N.E.
Cloudy and dull.
3
89
74
N.W.
Clear and fine.
4
90
73
isr.w.
•14*
4
Wnriw 1 inr'M riApn m TAFPTinriTi linil
Evening cloudy.
5
73
79;
N.
Clear and fine.
6
62
68
N.
Clear and fine. Evening overcast.
w.
2
XVdrllX 111 1 1 n 1 1 1 1 1 1 1 V WIUULI^ CLXILL LlUll.
Q
O
86
88
w
vv .
Uull and overcast. Juvening clear.
Q
v
91
86
w
vv .
Olear and tine, xuvening xiazy.
10
93
88
w.
Morning misty. Cloudy. Evening
dull.
11
53
79
N.
Clear and fine.
12
88
77
W.
Cloudy and fine.
13
75
79
E.
•04-*
A
t:
Snow in morning. Cloudy. Evening
clear.
14
72
N.W.
J-X^JCtl llUoU cfcllU ' '"-^ o' v^lCdl .
Evening hazy.
79
89
vv .
Hoar frost and haze in morning.
Clear and fine.
16
91
59
N.W.
Clear and fine.
17
70
79
N.
Cloudy and dull.
18
91
92
W.
Cloudy and dull.
19
99
85
E.
Morning foggy. Cloudy and misty.
20
91
87
W.
Cloudy and misty. Thick fog at
intervals. Hoar frost at night.
21
88
W.
Hoar frost and haze morning and
evening. Cloudy. Evening clear.
22
92
86
w.
Cloudy and dull.
23
82
90
w.
Dull and overcast
24
90
99
w.
■53
17
Overcast and rain.
•2b
96
90
E.
•13
20
Overcast and rain.
26
91
89
S.E.
•50
18
Overcast and rain.
27
95
74
E.
•11
8
Rain in morning. Cloudy and dull.
28
85
88
E.
Dull and overcast.
* Melted Snow.
55
Meteorological Observations taken at Glasgow Observatory from
16th January till 28th February, 1902.
Day
01 Tine
Month
Humidity
per cent.
Midnight to Midnight.
>-
X b ilj iVl ii. A A. O >
Wind.
Rain.
9 a.m.
9 p. m.
General
Direction.
Inches.
Hours.
Jan.
16
Q A
o4
y J
w.
Dull.
17
O X
00
88
W.
Overcast. Cloudy at night.
18
97
oU
C! WT
b. W .
Fog in morning. Dull.
19
yo
o7
CI ^TT
0
Dull. Squally and rain at night.
20
Q/f
yo
vv.
4y
1 7
Heavy rain m morning. Dull, blight
I'ain at night.
21
yb
A PC
yo
b. W .
oy
90
Overcast and rain.
22
y 1
Q7
y /
b. W .
•m
Dull. Slight drizzle morning and
night.
23
00
i 0
b. W .
•A/)
U4
0
Drizzle in morning. Dull. Kain alter
11.20 p.m.
24
94
80
WT
•47
15
Overcast and rain. Showers of snow
afternoon and night.
25
64:
w.
.AO
1
Slight snow in morning. Cloudy.
Evening clear.
26
Ob
/ 4
■\T WT
JN. W.
Clear and line. Evening dull.
27
b 1
yo
Jcj.
Dull. Snow after 2 p.m.
28
Q Q
OO
Do
JN .
10
1 o
Snow in morning. Cloudy. Evening
clear. Snow lying 2| inches deep.
29
00
"VT WT
JN . W.
•AQ
uy
0
Snow in morning. Clear and fine.
Snow lying 5i inches deep.
30
1 on
00
t? ^
WJ
Hoar frost and fog.
31
oO
Hi.
Hoar frost and fog in morning. Even-
ing clear. Aurora about 11 p.m.
Feb.
1
00
T?
Ih.
Hoar irost and sno'w lying in morning.
Fine. Evening dull.
2
85
89
ill.
•01
3
Dull. Slight rain at night.
3
OO
/ 0
E.
Slight rain in morning. Cloudy and
A 11
dull.
4
oO
Hi.
Morning hazy. Dull and overcast.
5
/ b
7Q
< y
O TXT
b. W .
Hoar frost in morning. Dull and hazv.
6
QA
oU
QQ
yo
Q WT
b. W .
(JO
9
Overcast. Rain between 5 and 7 p.m.
Evening cloudy.
7
U _/
JN .ili.
Hoar frost. Cloudy and hazy. Evening
dull.
8
T Q
/ O
b 1
.A ^ *
U4^
Q
o
Slight snow morning and night.
Cloudy.
9
oO
Ob
WT
Snow lying ^ inch deep. Fine.
TT' ' 1 A 1 J O
xiivening clear. Aurora about 8
10
( 0
/ 4
WT
p.m.
Morning hazy. Clear and fine.
11
DO
bO
AT WT
JN . W .
Hoar frost and haze in morning.
Clear and fine.
12
0 J
7 ^
/ 4
WT
W.
0/*
o
O
Snow in morning, 1 inch deep. Clear
and fine.
13
1 on
70
1 _j
b.
Hoar frost in morning. Foggy. Snow
lying.
14
ob
7i?
/ b
vv .
jNIorning dull and snow lying. Cloudy.
Lunar halo and corona at 7 p.m.
15
00
00
b. W.
Hoar frost and fog in morning. Fine.
Evening dull.
16
oO
o
b.
Dull and overcast.
17
53
70
TP
Jli.
Dull and hazy.
18
68
95
E.
Morning hazy. Fine. Evening dull.
19
85
85
E.
Dull and overcast.
20
86
96
S.E.
Dull and overcast.
21
87
87
S.
Dull and overcast.
22
88
89
S.E.
•16
5
Overcast. Rain after 8 p.m.
98
93
E.
•39
11
Morning showery. Overcast. Heavy
rain at night.
24
84
91
E.
•34
13
Overcast and rain.
25
94
90
N.E.
•05
5
Rain in morning. Cloudy and dull.
26
80
77
E.
Cloudy. Breezy.
27
90
87
E.
■oVt
6
Snow in morning. Afternoon showery.
Dull.
28
91
97
N.E.
•30
12
Overcast and rain. Evening cloudy.
* Melted Snow. f Rain and Melted Snow.
56
MAY, 1900.
Temperature, &c., as depending on the Direction of the Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
Min.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Rain.
Average
Daily
Rain.
Hourly
Velocity of
Wind.
Deg.
Deg.
Deg.
Hours.
Hours.
Inches.
Inches.
Miles.
North,
1
47-8
55
42
4
4-0
0-00
0-00
8-0
North-East,
1
46-4
56
38
9
9-0
0-00
0-00
7-0
East,
9
47-8
54
42
33
3-7
0-42
0-05
9-7
South-East, ...
1
48-9
58
42
4
4-0
0-20
0-20
10-0
South,
3
50-7
55
46
8
2-7
0-61
0-23
17-3
South-West,
6
51-2
57
46
18
3-0
0-81
0-14
13-8
West,
7
50-2
58
44
44
6-3
0-04
0-01
11-3
North- West,
3
54-0
64
45
33
11-0
0-00
0-00
9-3
JUNE, 1900.
Temperature, (fee. as depending on the Direction of the Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
Min.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Rain.
Average
Daily
Rain.
Average
Hourly
Velocity of
Wind.
North,
0
Deg.
Deg.
Deg.
Hours.
Hours.
Inches.
Inches.
Miles.
North-East,
3
54-5
66
47
9
3-0
0-04
0-01
8-7
East,
9
54-8
65
49
50
5-6
2-20
0-24
9-9
South-East, ...
1
58-8
66
48
1
1-0
0-00
0-00
6-0
South,
3
57-5
65
52
5
1-7
0-43
0-14
11-0
South-West,
5
56-9
64
51
25
5-0
0-57
0-11
8-8
West,
8
57-4
65
52
56
7-0
MO
0-14
8-4
North-West,
1
55-4
60
50
4
4-0
0-00
0-00
9-0
57
DECEMBER, 1900.
Temperature, &c., as depending on the Direction of the Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
Min.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Rain.
Average
Daily
nam.
Average
Hourly
Velocity of
Wind.
North,
0
Deg.
Deg.
Deg.
Hours.
Hours.
Inches.
Inches.
Miles.
North-East,
3
39-9
42
38
0
00
1-45
0-48
8-0
East,
4
40-7
43
39
0
0-0
M6
0-29
8-8
South-East, ...
2
42-4
44
41
0
00
0-40
0-20
7-5
South,
1
41'7
49
39
0
0-0
0-06
0-06
7-0
South-West,
18
4G-7
49
43
5
0-3
3-71
0'21
20-0
West,
2
39-8
44
37
5
2-5
0-43
0-22
16-0
North-West,
1
42-5
45
41
0
0-0
013
013
19-0
JANUARY, 1901.
Temperature &c., as depending on the Direction op the Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
Min.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Rain.
Average
Daily
Rain.
Average
Hourly
Velocity of
Wind.
North,
0
Deg.
Deg.
Dog.
Hours.
Hours.
Inches.
Inches.
Miles.
North-East,
4
38-6
43
35
0
0-0
0-39
0-10
10-3
East,
8
37-0
39
34
2
0-3
0-24
0-03
10-1
South-East, ...
1
38-G
43
34
0
0-0
0.00
0-00
9 0
South,
0
South- West,
8
42-1
45
39
5
0-6
0-40
0-05
IM
West,
6
39-1
45
35
2
0-3
1-12
0-19
18-2
North-West,
4
36-6
41
32
10
2-5
0-31
0-08
15-8 j
58
FEBRUARY, 1901.
Temperature, &c., as depending on the Direction of the Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
MiD.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Average
Daily
Rain.
Average
Hourly
V^elocity of
Wind.
North,
4
Deg.
34-3
Deg.
38
Deg.
30
Hours.
20
Hours.
5-0
Inches.
0-00
Inches.
0-00
Miles.
7'3
North-East, ...
• 1
38-4
42
35
3
3-0
0-00
0-00
8-0
jiast;.
0
00 Zi
A 9
V o
U Jo
V UD
1 u
iSouth-East, ...
1
42-3
44
39
0
0-0
0-50
0-50
9 0
South,
0
South-West,
0
West,
13
37-9
43
33
21
1-6
0-63
0-05
7-2
North-West,
4
34-8
40
30
14
3-5
0-14
004
6-5
JANUARY, 1902.
Temperature, &c., as depending on the Direction or
THE Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
Min.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Rain.
Average
Daily
Rain.
Average
Hourly
\'elocity of
Wind.
North,
1
Deg.
30-6
Deg.
37
Deg.
27
Hours.
1
Hours.
1-0
Inches.
0-15
Inches.
0-15
Miles.
7-0
North-East,
0
East,
3
26-9
32
21
0
0-0
0-00
0-00
o o
South-East,
0
South, ... ... ...
2
33-6
37
30
0
0-0
0-21
0-11
7-0
South- West,
9
44-8
47
42
0
0-0
1-28
0-14
16-2
■ West,
14
40-3
44
36
8
0-6
1-26
0-09
14-6
North-West,
2
28-5
33
24
10
5-0
0-09
0-05
10-5
FEBRUARY, 1902.
Temperature, (fee, as depending on the Direction of
THE Wind.
Direction.
Days.
Mean
Temp.
Mean
Max.
Temp.
Mean
Min.
Temp.
Total
Sun-
shine.
Average
Daily
Sun-
shine.
Total
Rain.
Average
Daily
Rain.
Average
Hourly
Yeiocity of
Wind.
North,
0
Deg.
Deg.
Deg.
Hours.
Hours.
Inches.
Inches.
Miles.
North-East,
3
37 '3
40
35
0
0-0
0-35
0-12
10-0
East,
12
37-1
40
34
8
0-7
0-85
007
10-9
South-East,
2
38-3
40
37
0
0-0
0-16
0-08
7-5
South,
3
33-3
37
30
0
00
0-00
O'OO
9-3
South-West,
3
34-2
38
30
3
1-0
005
0-02
8-3
West,
4
31-2
37
25
15
3-8
0-07
002
7-0
North-West,
1
29-0
33
27
7
7-0
0-00
0-00
7-0
CHART, A
SMALLPOX 1901 . (Epidemic PeriodJ
NUMBER OF CASES SICKENING DAILY.
CHART, B
SMALLPOX \^()\.-l(Recr,^esce^ceJ
NUMBER OF CASES SICKENING DAILY.
I90I
OCT
NO V EM B ER
D
f.CEM B ER
(*—
w
4
5i6j7j8l9
10
12
13
14
I5|I6
17
18
m
J2ib
^4
c 1
2
J
+ 56
716:9 l|0JM2l3l4;iSll6il7
22
262
7282
9»
il
—i
5-
>—
Itt
A
\
\
ii
J 1 ! 1
It
A
5—
— n-
I90E
JANUARY
FEBRUARY
MARCH
APRIL
M
A Y
J
u
N E
1 z 3
4
5
67 8
9
laii
I2il3!l4'l5|iei7
l8;i320Zle223|24!25|26
27
28
12980
51
l!2|3
4 5
e
7
8
9
10
12
14
15
16
17
IS
21
r>
illi
1
4
S
6
7
a
9
la
II
13
14
15
16
17
16119
20
21
22
2,1
24
25
26
27
28
29
56
31
1
2
3
4
5
6
7
S
on
12
15
1+
15
16
1?
18
19
20
21
22
23
24
25
26
29
n
SIT
1
z
3
4
5
6
7
8
9
10
II
E
13
14
15
I6|I7
l«
19
20
21
2?
2124
2i
2e
27!
28
29
1 (2
5
6
7
8
9
101
12
14
15
16
17
IS
19
20
21
22
23
2*
25|2e
2/
?B
n
30
j— 56—
■ i
r
50
i 50
' 1
4'0 -
t
1
-
— J«-
—
M
-
-
}
\
I
V
»
-M-
— ^e—
#-
7
I
t
1^
-
»
f
1
1 — 5—
— 6—
*
>..
4
\
V
•
»
■4
•
M
^
>i
1
1
—9—
1 I
COUNTY OF THE Citt OF GlhSGOW
J
a L.
ft*
EASTERN CASES SICKHNIKU.
Fortnight ending 2nd June, 1900, shown in black dot«.
„ IStli „ .. liUie
., !• 30tli ,, ,, , grtftu
MAP II.
1
I
I
"ME CI
LASGOW
I - A W
V
IlECKUDESCENCE -
Nuveniher, 1001, to Ut XUy, 1003.
Prior to Uth February shown in blue;
otlierK Bhowii in block.
. B L.
^
MAP VI.
;.
I
GORPOKATION OF GLASGOW^
THIRTY-SIXTH ANNUAL REPORT
ON THE .
OPERATIONS OF THE
SANITARY DEPARTMENT
/
OF THE CITY OF (GLASGOW,
For the Year ending olsf Decemljer, 1905,
BY
PETER F Y F E,
CHIEF SANITARY INSPECTOR.
Printed for the Corporation of Glasgow by
ROBERT ANDERSON, 14fi WEST NILE STREET, GLASGOW.
SANITARY ADMINISTRATION
THE CORPORATION OF THE CTfY OF GLASGOW,
BEING
The Local Authority of saici Citij under the Public Health
'(Scotland) Act, 1897.
The Honourable WILLIAM BILSLAND,
Lord Provost.
The Committee on Health administers all jjortions of said Act relating to
" General Nuisances."
Coiiweiier— Councillor W. FLEMING ANDERSON.
MEMBERS OF COMMITTEE ON HEALTH.
Dean of Guild (Robert King).
Bailie Burrell.
Bailie Roderick Scott.
Councillor MiCHAEL J. Connell,
and
Councillor James Henderson.
And the following Members forming the
SUB-COMMITTEE ON HOSPITALS.
The Lord Provost.
Bailie E. Watson.
Bailie D. Willox.
Councillor W. F. Anderson.
Councillor John Battersby.
Councillor Hugh Brechin.
Councillor James Coutts.
Councillor James Dick.
Councillor Garey.
Councillor Guest.
Councillor C. R. M'Lean.
Councillor Thomas Paxton.
Councillor W. F. Russell.
Councillor Robert Sloan.
Councillor James Willock.
Councillor James Steele, Convener.
Medical Officer of Health —
A. K. Chalmers, M.D.
SUB-COMMITTEE ON SANITARY OFFICES,
OPEN SPACES, &e.
Bailie D. Willox.
Treasurer D. M. Stevenson.
Councillor W. F. Anderson.
Councillor John Battersby.
Councillor Hugh Brechin.
Councillor Charles J. Cleland.
Councillor Robert Kirkland.
Councillor Alex. B. Kirkratrick.
Councillor Thomas Paxton.
Councillor James Steele.
Councillor James W. Stewart.'
Councillor Sutherland.
Councillor Wm. Maclay, Convener.
Sanitary Inspectoi' —
Mr. Peter Fyfe.
Bacteriologist —
R. M. Buchanan, M.B.
Corporation CJiemist and Analyst —
CM. Mr. F. W. Harris, F.C.S.
Physician Superintendents —
Belvidere Hospital — John Brownlee, M.D.
Ruchill iZ^ospitaZ— Alexander Johnston, M.D.
Clerk to Local Authority under tlie Pahlic Health Act —
Mr. A. W. Myles, Town-Clerk.
Public Vaccinator — Neil Carmichael, M.D.
Procurator-Fiscal — George Neilson, LL.D.
Treasurer (Police Department) — Mr. James D. Borthwick.
Sanitary Chambers,
23 Montrose Street, Glasgow.
STAFF OF SANITARY INSPECTOR'S DEPARTMENT.
INDOOR STAFF.
Public Enquiry Room,
Chief Inspector\i Eoom , ...
Central District,
Northern ,,
Eastern ,,
Southern ,,
Western ,,
Sub^irhan Districts,
Typists,
Draughtsmcm ,
Joiner,
Engineer and Caretaker of Chambers
P. B. Mackintosh, with 3 Assistants.
George Anderson, , , 3 , ,
James Neil, , , 2 ,,
William M 'Keith.
Hugh P. Dempster.
D. M'Calliim.
Wm. J. Allen.
William M'Neil, with 2 Assistants.
Miss J. Barr and Miss E. R. Walker.
John Burnside.
John MacAdie.
Thos. Boyd, with 6 Cleaners.
8 District Inspectors —
Henrj' Watt (Central).
James Paterson (Southern).
Robt. N. Crawford (Eastern).
S7 Nuisance Inspectors —
Robert Allan (Xorthern).
Robert Allan (Southern).
Wm. Brymer (Central).
Arch. Chalmers (Eastern).
John Donaldson (Northern).
J. 0. Eerguson (South-Sub.).
William Eraser (Northern).
Joseph Hepburn (Western).
OUTDOOR STAFF.
Christopher Eletcher (Western).
John P. Hart (South-Suburban).
William Miller (Northern).
John Hillis (Western).
William Latto (Central).
Joseph Martin (Eastern).
Jas. S. Murray (North-West).
A. M'Callum (Western).
Alex. Macdoiigall (North-West).
William M'Ghie (Central).
Charles M'Jarrow (Eastern).
Jas. L. Dobson (North-West).
Hugh Wood (Kinning Park),
Peter M'Killop (Eastern).
John Purcell (South-Suburban).
William Ramsay (Northern).
John Robertson (Soutli-Sub. ).
Thos. D. Seton (Northern).
Jas. Wedderspoon (Southern).
Alex. Young do.
Jas. Algie (Northern). John Boyd (Eastern). David Porter (Southern). Wm. Roy (Central).
(These four are Special Drain and Plumber Work Inspectors, with 7 Junior Assistants.)
8 Female Inspectors —
Miss Dewar (Central).
Miss Jamieson (Southern)
Miss Cameron (Western).
Miss Crawford (Eastern).
Mrs. Stewart do.
Miss Allan (Northern).
Miss Seott (Northern).
Mrs. Crabb (North-West).
6 Night Inspectors of Ticketed Souses —
David Gellatly. David Myles.
James Hutchison. Andrew Logan.
Inspector of Common Lodging-Houses and Boarding-Hoiises,
Do. Shipping in Harbour ( Port Local Aidhority ), ..
James M'Grath.
John Stuart.
6 Factory and Workshop Inspectors —
R. L. Ashford (Central).
T.S. Logie do.
4 Food and Drugs Inspectors —
Wm. Denovan.
Shop Honrs Inspector,
Fish Inspector,
4 Inspectors of Smoke,
Alex. M'Gilvray (Central).
J. Hannah (Eastern).
D. Macpherson.
Geo. Maconnachie.
A. M 'Cowan (Northern).
J. Patterson (Southern).
A. B. Findlay.
M. Kerr.
Allan Miller.
... ... ... Wm. T. Armstrong.
Geo. B. Harvey.
Colin B. Park, Henry J. Mackay, Alex. Gunn, and John Young.
15 Caretakers of Open Spaces and Children's Playgrounds.
Indoor Disinfecting Staff.
Thomas B. Watson and 4 Whitewashing Assistants.
Outdoor Disinfecting Staff.
Belvidere Wash-Home —
Robert Easton (Superintendentl. John Mackay J Engineer), and 9 Male and 10 Female Employees.
Ruchill Wash-House —
Ered N. Banks (Superintendent), Jas. Clarkson (Engineer), and 9 Male and 10 Female Employees.
INDEX.
Sanitary Administration —
Local Authority and Officials, ------ ^ - - 3
Staff of Sanitary Inspector's Department, ------ 4
Index, ------- ----- - 5
Inspector's Report, ----------- 7
Skeleton Map.
Appendix I. —
Table showing the Area in Acres ; Persons per Acre ; Houses Inhabited ;
and the Estimated Population (compared with last year and the
Census of 1901): also Houses Ticketed for Night Inspection;
Common Lodging-houses, Seamen's Boarding-houses, and Farmed-
out Houses on the Registers ; the Number of Nuisances recorded
per Acre, per 100 Houses inhabited, and per 100 Workshops in
each of the 26 Wards of the City of Glasgow, for 1905 ; with
a Skeleton Map attached, showing the Boundaries and relative
position of each Ward ; and the Number of Stables for Horses
in each Ward therein, --------- 32-33
Appendix II. —
Nuisances dealt with, ---------- 34-3-5
Smoke Testing of Drains, --------- 34-35
Common Lodging-houses and Boarding-houses for Emigrants, - - 36-37
Ship Inspections under the Port Local Authority, - - - - - 36-37
Houses Let in Lodgings and Farmed-out Houses, . - . - 36-37
Night Inspections for Overcrowding, ------- 36-37
Visits by the Lady Inspectors, -------- 38-39
Infectious Diseases, Disinfections, ikc, ------- 38-39
Vaccinations (Free), ---------- 40-41
Bakehouses Inspected, --------- 40-41
Factories, Workshops, and Home Workers, ------ 40-41
Smoke Prevention, ----------- 42-43
Byres, Dairies, and Milk Shops, -------- 42-43
Unwholesome Food, ---------- 44-45
Food Adulteration, ---------- 44-45
Margarine Act, Contraventions, -------- 44-45
Fish and Game Inspections, --------- 46-47
Limewashing of Ashpits (Cholera Precautions), - . - - . 46-47
Pteception-Houses (for Quarantine), ------- 46-47
Interments under the Public Health Act, 1897, ----- 46-47
Shop Hours Act, Inspections, -------- 46-47
Seats for Shop Assistants Act, Inspections, ------ 46-47
Appendix III. —
Return of the Work done. Materials used, (fee, at tlie Wash-house at
Belvidere, ------- - - . 48
Appendix IV. —
Return of the Work done, Materials used, cfec, at the Wash-house at
Ruchill, ------------ 48
Appendix V. —
Statement of Time and Material in the carrying out of Repairs done by
the Staff, 49
Appendix VI. —
Abstract of Workshops Measured and Registered during the year,
including Restaurants, --------- 50-52
Appendix VII. —
Total Number of all Workshops and Employees on the Registers, - - 53-56
Appendix VIII. —
Complaints and Notices from H.M.'s Inspector of Factories, - - - 57
Appendix IX. —
Kinning Park Sanitary Inspector's Report, ------ 58-61
THE
SANITARY CONDITION OF GLASGOW
In 1905.
To THE Honourable the Lord Provost and Members
OF the Corporation.
My Lord Provost and Gentlemen,
Judged by tlie rougli-aud-ready standard of the
death-rate, Glasgow may be considered a healthier city in 1905 than it has
ever been before. In his summary for the year. Dr. Chalmers shows that the
^ number of persons who died during 1905 was 953 less than died in 1904, and
642 less than died in 1903. The actual death-rate for 1905 was 18"0, in place
of 18"8 in the previous year.
On the other hand, infectious diseases appear to have been more numerous.
Eliminating Phthisis, Diarrhceal Diseases, Chickenpox, and Anthrax, there were
3,099 more known cases in 1905 than in 1904. This increase is more than
accounted for by the prevalence of Measles, of which there were 4,197 cases
more than in the previovis year.
The greatest diminution occurs in the cases of Smallpox, only 4 being
recorded last year, against 870 in 1904. Scarlet Fever and Enteric also show a
considerable reduction— 589 cases in the former and 177 cases in the latter. It
is satisfactory to note that as many as 1,858 cases of infectious diseases were
discovered and reported by the officers of the epidemic staff.
What are known as zymotic diseases caused 1,998 deaths, or 104 fewer than
in 1904 — a happy result, when one takes into account the large increase in
known cases last year.
Owing to the successful struggle of the Health Department against Small-
pox, re-vaccinations have enormously declined, only 1,003 persons having been
operated on, in place of 11,164 in 1904. 306 primary vaccinations were done
in the Office and the Hospitals during the year.
DISINFECTION.
11,608 apartments, lobbies, and closets were disinfected by spraying or
fumigation during the year, and 660 over and above this were whitewashed.
11,487 beds and pillows were treated at the two Sanitary Wash-houses in the
steam disinf ectors ; 694 carpets were dealt with, and 492,812 articles of clothing
were washed ; while 4,622 bundles of clothing were of such a nature that they
had to be speciall}^ treated under steam pressure. The number of infected
beds destroyed by fire was 2,175.
In the washing process, 16,829 lbs. of soap and soap powder were used, or
about 51 ounces per article treated.
During the year a high-pressure " Decoudun " ironing machine was erected
at the Euchill Sanitary Wash-house, which has expedited the work of drying,
besides enabling the Department to send home many of the larger linen and
cotton articles in a much more workmanlike condition than formerly. So
successful has this addition been, that I propose this year preparing plans for a
similar addition to the plant at Belvidere Wash-house.
NUISANCES.
414,722 separate inspectious for tlie discovery of uuisauces were made by
the male staff and 57,981 by the female staff during 1905, resulting in the
discovery of 44,979 nuisances by the former and 1,625 by the latter.
The female staff, in- addition, visited on 1,848 occasions the Board schools
in quest of dirty and verminous children, under Section 15 of the Glasgow Cor-
poration (Police) Order, 1904. 4,221 children were submitted by the School
Board officials for inspection, and, out of these, 2,636 were found to be in a
dirty or verminous state. The homes of the affected children were carefully
inspected — 165 of which were found in an unclean state, and in 161 cases the
bedding was found in a filthy condition. Only in five cases was it found needful
to put into operation the full powers of the Act, and take the children from
their parents in order to have them cleansed by the officials of the Corporation.
In these cases this Avas done in the Reception-houses by the Matrons and their
staff. With two exceptions, the cleansing of the filthy bedding and houses
was done in every case by the occupiers on receipt of the statutory notice.
The Act is a summary one, and it is working excellently in the public
interest, but, notwithstanding this, Avhen a recalcitrant person is met with, a
large amount of valuable time is spent before he can be compelled to conform
to the law. An illustration will best exhibit this.
On the 21st of March, 1905, three children of a man, A. G., were brought
before the attention of one of the female inspectors in a school on the south side
of the river. Two of them were found verminous and dirty, and the third one
dirty only. Notice was sent, and for a time some improvement was made. On
re-examination, however, on the 18th of April, all three were again found in
the same filthy state. Proceedings were taken, under Section 9 (2) of the Order,
against the father on the 21st of April, when he was convicted in the Police
Court, and ordered to cleanse the bed and body clothing in the house fortliAvith.
On 25th April I sent two of the female inspectors to ascertain what progress had
been made, but admission to the house was refused. An application, accordingly,
Avas made to the Magistrate next day for a warrant for forcible entry. Armed
with this, the two inspectors on the following day gained access to the house,
and found that the clothing of the children had been cleansed.
On the 2nd of May the school was again visited, and the same three children
were found as bad as before. Arrangements were there and then made for
their removal from the school to the Reception-house in South York Street on
the 3rd of May at 11 a.m., Avhere they Avere thoroughly cleansed, and detained
until their clothing had been treated at the Sanitary Wash-house. They were
then sent back to their parents at 8.20 p.m.
Fully twenty-eight hours were spent in this duty by each of the inspectors
engaged, apart from the time and trouble taken with the children at the
Reception-house and with their clothing at the wash-house. Even yet neither
the house nor the chilHren are in a cleanly condition, as I found on a personal
visit recently. The family are of the alien tribe — one of Avhose chief character-
istics appears to be, like that of the saints and hermits of early Christian times,
a desire to live amid filth and disorder.
In September, additional Avork in connection Avith the visitation of ncAvly-
born infants Avas put upon the female inspectors, particularly in homes Avhere
the services of the maternity nurses were required. Doubtless much good and
useful Avork has been and is done by them in this direction, but, as this class of
Avork groATs, it unavoidably retards the progress of their operations in the
domain of house-to-house visitation and inspection. I find, from a recent
return of their inspections of the loAver-class dAvellings, that, AA^hereas from
January and February, 1904, they had inspected 16,240 houses, only 7,670
visits had been paid to similar houses during the same months in 1906.
The regular inspection of children in the schools, and the consequent
visitation in the homes of those found in a filthy or verminous state, have con-
tributed to this great reduction in their regular house-to-hoiise visitations ;
still, the continual visitation, for statistical and advisory purposes, of houses
9
in whicli infants are born, has largely caused the reduction specified. As time
jDroceeds, I fear, on this account, it will be advisable to consider the expediency
of appointing a special stafi of trained visitors for infant-mortality work alone.
With regard to the ordinary nuisance-inspection work, the following seven
Sanitary Districts head the list as nuisance producers, viz.: —
Ward XVI. (Cowcaddens), ... 3,307 nuisances, or 19-11 per acre.
XIV". (Sandyford), ... 2,141 ,. or 15-52
IX. (Blackfriars), ... 2,022 „ or 14-00
„ XVIII. (Hutchesontown), 2,866 „ or 12-80
XIX. (Gorbals), ... 2,231 „ or 9-19
XII. (Broomielaw), ..: 950 or 9-13
II. (Calton), ... 2,578 .. or 8-00
The average for the City was 3'35 nuisances per acre for the year, or
slightly under the figure for 1904, which was 3"50.
The relative position of the other wards in the City in this respect and
other information of interest therein will be found detailed in Appendix I.
It may be noted here that the ordinary nuisance statf were specially
engaged, for the purposes of the Provisional Order of 1905, in an organised
inspection of the 2,573 stables within the City boundaries, which will be
referred to in detail under a special heading. The number of these found in
each ward is given in Appendix I.
MOYEME^^T OF POPULATION.
A few words may be added here as a probable explanation of the figures
showing the increase or decrease of houses and population in some of the wards
since last year and since the Census year, 1901.
Ward I. (DalmarnocTi). — ISTo tenements in this ward have been removed,
but, since the erection of the new Corporation Gras-works at Provanmill, large
numbers of the workers have left to take up house nearer the new works ; others
have removed to "Ward III. (Mile-end), to be nearer the Parkhead Porge ; and
in other cases it has been ascertained that a number of families in this ward
have emigrated to Canada. Consequently several streets here have, from being
well populated, become greatly denuded of their population, and there are many
empty houses.
Ward III. (MUe-end ). — A large number of new tenements have in recent
years been erected in this ward round about Parkhead Cross and the Forge,
which, as indicated above, have attracted a considerable number of families
from adjacent wards.
Ward IV. (Whitevale). — A number of low-class tenements have been con-
demned in this ward, and taken down. There are also many houses remaining
presently unlet, the people having migrated to newer dwellings in other wards.
Ward V. (^Detmisfonn). — Much new building has in recent years been done
in this ward, particularly about Alexandra Park and its immediate neighbour-
hood, which accounts for the increase shown in the table.
Ward VI. ( S prinqhurn ) . — Around Petershill Poad and Springbum Road,
and in Bedlay Street, a large number of new tenements have been erected, the
increase of population consequently being almost as great as that in Ward Y.
Ward VII. (Cowlnirs). — The same remark applies to this ward, in which,
on the north and south sides of Keppochhill Eoad and vicinity, much building
of new tenements has been proceeding.
Ward VIII. (Toicnhead ). — It is not possible to explain the specific reasons
which have led to a reduction of 1,63G persons in this ward since 1901. Many
houses are reported to be empty and " to let." Probably it is due to families
flitting to newer tenements in the adjacent ward of Springburn. A few tene-
ments in Garnkirk Street and Coatbridge Street have been removed, but these
were not sufficient in number to account for the rediiction specified.
10
Ward IX. (Blach friars). — The diminution in population of this ward is
serious — 1,956 since last year, making a total of 9,284 since the Census year
(1901). It is in a great measure due to the destruction of many old tenements.
Eight or nine tenements lying on the Avest side of High Street, and extending
north to Bottenrow, have been removed by the Improvement Trust, and re-
placed by buildings of modern construction. In Stockwell Street also, from
Bridgegate to Goosedubbs and Aird's Lane, four tenements have been taken
down, and reconstruction is proceeding. The old tenements in Bridgegate,
from St. Margaret's Place eastwards to Saltmarket Street and southward to
Jail Sqiiare, have been demolished, and new buildings are being erected. In
this ward on the south side of the river, the demolition of insanitary back lands
behind Rose Street and Crown Street has occurred, whereby much-needed light
and air have been let in to what were previously dismal and evil-smelling courts,
where nuisance of every description was constantly present. These, of course,
cannot be reconstructed.
Ward XI. (Blythswood). — In this ward, house demolition has been going
on in Renfield Street, from Renfrew Lane up to Renfrew Street, in order to
make room for the new " Pavilion Theatre of Varieties." A large tenement at
the corner of Sauchieh'all »Street and Cambridge Street, and also one
at 90 Sauchiehall Street, have been removed and replaced by warehouse
premises.
Ward XII. (Broomielaw). — Representations and demolitions under the
Housing of the Working Classes Act, 1890, have mainly been the cause of the
reduction of the population here. It was miich needed. The sanitary district
formerly known as " Brownfield " was for long the sorest spot in Glasgow. It
is now getting comparatively respectable. At 29 Brown Street, 67 Brown
Street, 9 Carrick Street, 20 Carrick Street, 29 West College Street, 14 M'Alpine
Street, and 53 M'Alpine Street, many back-land dwellings have now disappeared,
and can never be replaced. The tenements at the corner of West Campbell
Street and Cadogan Street, and also at the corner of Argyle Street and Pitt
Street, have been entirely removed and reconstructed. Other undesirable
buildings still remain, but in time means may be found to accomplish their
demolition also. In no district has more satisfactory work been accomplished
in recent years.
Ward XVI. (Coivcaddens). — The marked decrease here is accounted for
by the closure and destruction of insanitary property in M'Adam Lane, Mait-
land Street, Maitland Lane, Muse Lane, Stirling Street, Water Street, Milton
Street, Debbie's Loan, Renfrew Street, and Ann Street, while many damp
underground dwellings in Grove Street, Abercom iStreet, and vicinity have been
closed under the Public Health Act. Further work of this nature still remains
to be accomplished before this Avard can be said to be in a reasonably healthy
state.
Ward XVIII. (Ilutchesontown). — A large increase of population has
occurred here since 1901. It is one of the expanding wards of the City, much
building of new tenements having been done during the past four years. The
temporary set-back since 1904 is probably due to migration to other districts
or to parts outwith the City.
Ward XIX. ( Gorhals). — New tenements have recently been erected in this
ward in Cuthbertson Street, Langside Road, Yictoria Road, Coplaw Street, and
Cromwell Road, Avhich accounts for the increase of houses and population
recorded.
There is little worthy of special note in the remaining wards. Govanhill,
Langside, Pollokshields, Kelvinside, and Maryhill — lying, as they do, on the
fringes of the City — all naturally shoAv a great expansion, due to the overfloAv of
the population to the suburbs. The Avhole movement exhibits a displacement
of population to the extent of some 40,000 persons. This is the general tendency
at the present time, and, doubtless, is a natural one, facilitated by cheap transit
by tram-car and a vast amount of house building on the outskirts.
UNINHABITABLE AND TICKETED HOUSES.
As a very full report was issued in the first niontli of this year showing the
operations of the " Back Lands Committee," it is unnecessary here to dwell upon
the good work which has been done during 1905 with regard> to uninhabitable
dwellings. The operations were carried out under the Housing of the Working
Classes Act, 1890, Part II., and, to allow of the free play of this Act, no work
has been carried out under Section 32 of the Local Police Act, which gives
power to close, but not to demolish, uninhabitable dwellings.
Regarding ticketed houses, our operations have been extended by the
additional powers of ticketing given by the Provisional Order of 1904. The
following statement in tabular form exhibits the state of matters at the present
time : —
Ward.
Total
No.
Giving
Accommodation (at 400 cuhic feet per Adult) for
2
Adults.
21
Adults.
3
Adults.
Si
Adults
4
Adults
4i
Adults
5
Adults
Adults
6
A emits
61
Adults.
1
1,389
19
no
189
214
235
244
92
128
110
8
40
2
1,601
29
201
290
238
203
150
147
277
18
16
32
3
2,203
20
151
372
384
304
266
332
334
17
6
17
4
953
13
71
145
203
154
76
51
142
13
39
46
5
201
5
31
55
27
25
19
20
16
3
6
1,409
12
45
140
287
259
271
160
216
9
5
5
7
409
■->
21
33
75
83
46
59
69
11
6
4
8
1,333
21
118
210
186
112
103
124
279
78
71
31
9
756
16
69
78
106
70
158
153
82
17
6
1
10
8
6
2
1 1
I
4
12
484
8
24
48
30
62
57
86
76
26
27
40
13
1,650
17
121
217
216
222
130
154
259
166
87
61
14
817
25
95
162
168
83
57
85
80
37
19
6
15
16
2,843
29
227
413
452
361
263
342
396
176
105
79
17
723
4
30
75
206
105
70
79
49
33
36
36
18
969
2
61
170
184
148
120
118
142
12
10
2
19
997
19
131
190
188
108
102
117
112
8
15
7
20
939
14
72
196
207
91
72
105
136
28
18
21
22
227
1
5
20
59
36
16
87
1
2
23
24
25
302
1
9
25
48
37
57
78
46
1
26
329
3
20
67
76
52
34
16
31
16
14
Total,
20,547
257
1,596
3,028
3,506
2,797
2,349
2,358
2,948
794
491
423
12
The work accomplislied by the night statf is shown in the following abstract
Table, which has been prepared from their weekly returns. For convenience,
the figures are given as applicable to the seven Police Divisions of the City: —
a
_o
Houses
Overcrowded.
Prosecutions.
■tment
ted.
ftment
ted.
*-3
o
^ 2
Police
Division.
No. of Inspe^
No.
Percentage on
Inspections.
No.
Percentage on
Cases found.
Number
of Convictions.
No. Fined.
Amount
of
Fines.
No. of One-Aj
Houses Insj:
No. of Two- A]
Houses Insj
1
2
3
4
5
6
7
8
£ s. d.
9
10
Centi'al, -
1,547
95
6-14
40
42-10
29
10
1 12 6
1,085
462
Northern,
7,426
643
8'65
334
51-94
261
153
28 13 0
4,200
3,157
"Western, -
6,560
509
7-75
236
53-75
201
108
23 0 6
3,255
.2,629
Southei'n, -
8,614
636
7-38
277
43-55
205
94
22 6 0
5,573
3,010
Eastern, -
14,229
1,029
7-08
426
41-39
277
113
21 9 0
10,329
3,900
Maryhill, -
614
31
5-04
16
51-61
12
6
1 2 6
537
75
St. RoUox,
7,485
404
6-01
192
47-52
132
41
9 18 6
4,641
2,003
Total, -
46,475
3,347
7-20
1,521
46-41
1,117
525
108 2 0
29,620
15,236
Cases of
Overcrowding in One
Apartments.
Cases of
Overcrowding in Two
Apartments.
Nature
of Overcrowding.
Extent
of Overcrowding.
CP
Average
Monthly Rents.
No.
Percentage.
No.
Percentage.
Wholly
by Lodgers.
By Families
only.
No.
with ^-Excess.
No.
with 1 Excess.
No. with
over 1 Excess.
No. of Hous
Empty.
One
Apartments.
Two
Apartments.
11
12
13
14
15
16
17
18
19
20
21
22
65
5-99
29
6-27
38
44
12
33
50
18
9/4
10/11
381
9-07
256
8-10
235
322
66
255
322
192
9/1
12/
266
8-17
167
6-35
154
222
55
177
277
70
10/2
11/2
430
7-71
198
6-57
239
309
15
280
341
122
11/11
15/10
747
7-23
272
6-98
353
552
18
463
548
462
8/5
9/10
23
4-28
8
10-66
17
14
3
11
17
12
8/1
14/2
309
6-65
85
4-24
99
238
12
159
233
138
8/11
9/5
2,221
7-49
1,015
6-66
1,135
1,701
181
1,378
1,788
1,014
9/5
11/11.
13
That the miisance of overcrowding is gradually being abated is shown by
the fourth column (the percentage last year being 8'48), while under the
sixteenth and seventeenth headings the nature of the overcrowding is exhibited ;
the next three columns give its extent ; and the last two show the average
monthly rent charged for a one and a two-roomed ticketed house. It will be
noted that the rents charged for single-apartment houses in the Southern and
Western Divisions are considerably in excess of those in the other districts.
The unoccupied ticketed houses number 1,014, which is almost 5 per cent,
of the total, 20,547.
FARMED-OUT HOUSES.
The following Table gives the figures for farmed-out houses in Glasgow
during 1905 : —
There is nothing of a special nature to report regarding them. Some of
them (in about a dozen properties) are houses of a suspicious character morally,
and strict supervision is constantly required in these, in order to keep down
nuisance.
Farmed-out Houses in the City as at 30th December, 1905.
One
Apartment.
Two Apartments.
Total Inmates.
Ward.
Total
No.
of
HoilSGS.
Total No.
Inmates.
Total No.
d
'A
Inmates.
Clj
No. Occu
No. Em]
Adults.
Children.
o
o
O
6
Adults.
Children.
Adult
Childri
2
293
172
155
17
327
80
121
110
11
344
135
671
215
3
25
25
21
4
43
10
43
10
4
67
27
25
46
8
40
36
4
115
38
161
46
5
33
16
16
34
7
17
17
67
6
101
13
6
16
13
12
1
24
8
3
3
6
3
30
11
8
83
75
71
4
147
32
8
6
2
23
5
170
37
9
148
54
53
1
112
37
94
94
321
74
433
111
10
16
1
1
2
1
15
15
54
6
56
7
12
85
23
22
1
44
18
62
62
203
96
247
114
13
112
75
69
6
130
45
37
34
3
93
42
223
87
14
65
65
38
27
82
26
82
26
16
11
11
10
1
20
3
20
3
18
49
31
30
1
56
25
18
16
2
46
11
102
36
19
48
23
20
3
45
10
25
21
4
74
12
119
22
20
63
38
38
142
34
25
23
2
30
14
■172
48
Total,
1,114
649
581
68
L254
344
465
437
28
1,376
442
2,630-
786
Note — 27 of the 2-apartment houses in Ward 2 have only 1 room occupied.
6 do. do. do. 9 do. do.
10 do. do. do. 12 do. do.
COMMON LODGING-HOUSES AND SEAMEN'S BOAEDING-HOUSES.
There were at the end of 1905, 63 Common Lodging-liouses on the Eegister,
with 9,768 beds, as against 56, with 9,346 beds, at the end of 1904. The
Seamen's Boarding-houses number 35, with 623 beds. No prosecutions were
instituted against keepers during the year.
The following Table will show the present position at a glance : —
Class of House.
Ward.
Inspections.
Complaints
Notified.
Complaints
Removed.
Houses
Measured
and
Registered.
Houses
Removed
from
Register.
2
1,288
71
68
A
3
19
1
I
1
1
4
316
14
14
5
43
I
Common
Lodging-
8
9
1 9
i /
47
1,013
Jit
2
51
i o
2
48
I*
5
1
I
1
3
i
HOUSES,
13
88
15
16
1
16
282
10
9
J. V
ovo
i o
20
79
2
2
25
44
1
1
Total,
4,041
194
190
12
5
Seamen's
AND
Emigrants' <
Boarding- 1
12
13
18
1,837
61
2
27
25
5
1
8
HOUSES,
I
20
572
8
8
1
2
Total,
2.472
35
33
7
10
Note. — 7 Lodging-houses and 4 Boarding-houses were transferred during the year to other keepers.
During the year further improvements of a structural nature have been
carried oiit in manj^ of the houses, and in five of them we got the existing beds
removed and replaced, and the bedding replenished.
A special detailed report has now been made on each common lodging-
house in the City, in view of re-registration in May, 1906. These reports
deal, inter alia, with the important subject of suitable exits in case of fire.
The deplorable disaster which occtirred in the lodging-house at 39 "Watson
Street, by which 39 sleepers were suffocated or burned to death, brought up
sharply the question of the powers given in the Public Health Act to deal with
such structural matters as doiible stairs for each donnitory, provision of
hydrants and hose attachments, composition of bunk beds, regular patrols
during the night, &c., all of which will doubtless engage the serious attention
of the Local Authority when the special committee appointed to enquire into
the causes of the disaster have formulated and issued their report. Meantime,
15
my report is before tJie Committee ou Health for their consideration. Nineteen
lodging-houses have been foimd with sanitary defects of one kind or another,
and 20 are specially reported on to the Committee as to the present state of
exits for the sleepers in case of fire breaking out during the night.
With regard to Seamen's and Emigrants' Boarding-houses, there has been
a decrease since last year. There are 35 of such houses on the Register at the
present time, with bed accommodation for 623 persons. Four of them are
exclusively used by foreign emigrants. In the others both classes may be
housed promiscuously.
2,472 inspections were made during the year in these lodging-houses, and
35 complaints were notified to the keepers, but in no case was it necessary to
resort to prosecution in the Police Courts. Improvements of a structural nature
were carried out, at the instance of the. Department, in several cases, consisting
chiefly of the abolition of filthy trough privies, the refitting of wash-down
water-closets, and the provision of sufficient iiriual accommodation.
The number of foreign emigrants who passed through the City during the
year was 8,335 — an increase of 3,936 over the number in 1904, and considerably
more than has passed during any year since 1S94. The following Statement
shows the number and nationality of these emigrants. It will be observed that
those of Jewish extraction are much in excess of the others : —
" Donaldson " Line.
Norwegians, ... ... ... ... ... ... ... 10
"Allan" Line.
Scandinavians (Norwegians, Swedes, and Danes),
Continentals (Russians, Austrians, Hungarians,
Poles, itc, principally Jews),
Finlanders,
Icelanders,
Russians, Poles, and Jews,
Finlanders,
Scandinavians, ...
Russians,
"Anchor" Line.
( Antwerp,
I Rotterdam,
Hango, ...
( Sweden,
■j Esbjerg,
( Norway,
Hamburg,
271
774
297
155
2,209
2,316
851
321
461
599
71
1,-197
6,828
Total, 8,335
Probably the late war, and the consequent upheaval in Russia, accounts
to a great extent for the increase this year, but we may look forward in the
future to a continuous stream of these aliens coming temporarily, if not per-
manently, among us, and it behoves us to carefully consider as to some suitable
means of so housing them that they may be kept more easily and more strictly
under the watchful care of the Health and Sanitary Authorities. Meantime,
they are too apt to be scattered among our population, and, to some extent, lost
sight of.
The Aliens Act was intended to prevent the " dumping " of undesirables
into this country, but it appears, if they come in in numbers not exceeding
twenty, they are allowed to pass the Immigration Officer without enquiry either
as to their circumstances or as to their health, and so the Act may be evaded.
Glasgow and the districts surrounding it have had a goodly number of this class
added to their population in recent years. America is very strict as to the
examination of such persons, and if any sign of disease of an infectious or con-
tagious nature is detected upon them, thej^ are at once returned here at the
expense of the Shipping Companies. Consequently, we have begun here to be
much more careful than hitherto in our examination of intending emigrants,
and the Medical Officers of the Board of Trade and the Shipping Companies are
most assiduous in the performance of their duty in this respect.
16
It will be noted that tlie Donaldson Line have now become caterers for this
class of trade for the first time, and have fitted up one of their steamers to carry
passengers.
PORT LOCAL AUTHORITY.
Two Boarding Medical Ofiicers and two Nuisance Inspectors at Greenock,
and one Nuisance and one Epidemic Inspector, with an Assistant, in Glasgow,
constitute, as previously, the daily working stafi connected with the port and
shipping.
The area in the City comprises Glasgow Harbour, the Docks in Govan,
Shieldhall, Torkhill, Partick, and Bowling. When the docks in course of
erection on the lower reaches of the river are completed, the area of inspection
will be correspondingly extended.
1,870 inspections and 287 re-inspections of steamers were made, while 95
inspections and 75 re-inspections were made in sailing vessels. 268 written
intimations and 10 final notices tinder the Public Health Act were served on
masters as to nuisances discovered, and 238 verbal warnings were given to
masters as to the defective state of their vessels.
The outstanding feature of the year has been the large number of French
sailing vessels which came to this port with cargoes of nickel ore from the
penal settlement of New Caledonia. This trade seems to be practically
monopolised by French " wind-jammers," as these ships are called, as not a
British vessel came to the Clyde from this French colony during the year.
The inspector reported that these ships are well appointed, the crews' quarters
being " roomy and comfortable, and in marked contrast to the forecastles of
similar British-owned ships."
Hndernoted will be found details of the inspections, re-inspections, &c.,
undertaken by my Inspector detailed for duty within the Glasgow area, as also
a record of the various nuisances discovered : —
Inspections —
Steamers, ... ... ... ... ... ... 1,870
Sailing vessels, ... ... .... ... ... 95
1,965
Re-inspections —
Steamers, 287
Sailing vessels, ... ... ... ... ... 75
362
Warnings given, ... ... ... ... ... ... ... 238
Intimations issued, ... ... ... ... ... ... 268
Final Notices served, ... ... ... ... ... ... 10
Nuisances Discovered.
Filth-
Floors, wood work, i&c, of cabins, officers' i-ooms, forecastles,
and stewards' and cattlemen's quarters dirty, ... 237
Old beds within forecastles destroyed, ... ... ... 172
Accumulations of gear and rubbish within forecastles, ... 23
Forecastle infested with vermin, ... ... ... ... 1
Live fowl kept in crews' quarters, ... ... ... ... 1
Cooking galleys dirty, ... ... ... ... ... 7
Bath rooms or wash-houses dirty, ... ... ... ... 15
Fresh water tanks or barrels to be cleansed, ... ... 15
Bilges in need of draining, ... ■ • . ' . • • • ... • • • 6
Scuppers choked, ... ... ... ... ... ... 7
"Walls and ceilings of water-closets dirty, . .. ... ... 75
"Water-closet troughs fouled or cori'oded, ... ... ... 62
Accumulation of gear within closets, ... ... ... 3
Total, 624
(Number remedied, 506.)
17
Structural defects —
Officers' rooms defective in ventilation, ... ... ... 7
Forecastles defective in ventilation, or ventilators plugged, 91 ' '
Forecastles inadequately lighted, ... ... ... ... 5
Forecastles damp, ... ... ... ... ... ... 4
Bunks in forecastle defective in construction, ... ... 1
Bogies or funnels defective, and new stoves or pipes required, 61
Ports, port glasses, (fee, leaking, broken, or otherwise defective, 109
Hatches, bulkheads, skylights, hawse pipes, casings, tfec, defective, 9
Overhead decks leaking, ... ... .. ... ... .32
Steam pipes defective, ... ... ... ... ... 2
Forecastle doors, tables, ifec, dilapidated, ... ... ... 5
Forecastle without scuppers, ... ... ... ... 1
Better accommodation for food stuffs required, ... ... 38
Water-closets without locks or keys (to prevent a nuisance), 121
No water-closet accommodation, or additional water-closets
required, ... ... ... ... ... ... 7
Wood work of closets worn out or broken, ... ... 9
New pans, flush tanks, or service pipes, (fee, required, ... 6
Water-closets deficient in light, ... ... ... ... 2
Water-closets defective in ventilation, ... ... ... 5
Ventilators of water-closets plugged, ... ... ... 2
Lamp room exposed to men's quarters, ... ... ... 1
Total, 518
(Number, remedied, 407.)
The " filth '" nuisances numbered 624, and structural defects were
discovered in 518 cases. Of the filth nuisances, 172 consisted of old beds, which
were either burned or taken ashore for removal by the Cleansing Department.
An improvement of much value has been eiSected in the majority of ships
carrying native crews, by the removal from the forecastles or sleeping places of
perishable food stuffs and drinking-water tanks to suitable positions on the
main decks, so that these are now free from contamination. In one Chinese
forecastle a number of live fowls were discovered living in common with the
men. Orders were at once given to have them removed to a proper coop on deck.
One case occurred on a foreign-owned vessel of a master disputing the
right of the Inspector to interfere in the matter of nuisance inspection, as he
thought liis ship was outwith Scottish supervision. It was explained that the
Port Local Authority's power in this respect was stronger than even the
Merchant Shipping Act, which only embraces in its sections the right to deal
with " any British ship,'^ while the Public Health (Scotland) Act gives powers
to inspect any ships except war vessels. The m^isances found on board were,
However, removed.
Intimation was sent to other Local Authorities in 25 cases, advising them
of filth nuisances and structural defects found here which could not be remedied
before the vessels sailed for their respective ports.
18
The following return shows the nationality of the ships which arrived
within the Glasgow district during the year 1905 as compared with 1904 : —
Nationality.
Number of Vessels.
1904.
1905.
Austrian,
20
20
British,
1,554
1,569
Belgian, ... ... ..:
1
4
Danish,
21
15
Dutch,
2
5
Eevntian, ...
1
Finnish,
1
1
French, ... ... ... . . . ,
29
41
German,
34
27
Greek,
7
4
Hungarian, ...
1
1
Italian,
34
26
Norwegian, ...
213
175
Roumanian,
1
Russian, ... ... ...
7
2
Spanish,
62
61
Swedish,
52
61
Total,
2,038
2,014
At the Boarding Station at Greenock, 2,014 vessels were either hailed or
boarded, and partially or carefully inspected. Of the incoming ships, 1,569
were British and 445 foreign. 410 vessels (of which 315 were British and 95
foreign) were notiiied for my attention at the various harbours on arrival.
Accumulations of manure on cattle-carrying steamers were reported to the
numbffr of 137. Almost immediately after such vessels were docked, shore
gangs of men are set to work to have the manure removed to barges, thence to
railway trucks, which convey it to the country; the decks and cattle stalls
are then thoroughly flushed, after which the compartments for the cattle are
re-limewashed — a process which is efficiently carried out in every instance.
20 tons 1 cwt. of oranges, ex s.s. " Iberia," from Valencia, which were landed
at Prince's Dock, were found to be unsound, and were sent to the destructors
in Glasgow.
19
Seven samples of ib inkiug water were taken from the tanks of vessels during
1905 by a special pnmp, whicli lias been designed for the purpose of drawing
from the bottom of the tanks. These were submitted to the City Analyst,
Mr. F. W. Harris. The results of his analyses are given in the Table
annexed: —
Analytical Report on Samples of Drinking Water Collected from Ships.
(All results expressed in grains per gallon.)
No. 1.
No. 2.
No. 3.
No. 4.
No. 5.
No. 6.
No. 7.
Appearance,
Odour at 212° F., -
iurbicl.
Slight.
Slightly
J'urbid.
None.
teligntly
Turbid.
None.
(Jlear.
None.
bligntiy
Turbid.
None.
Turbid.
None.
lurDicl,
None.
Free and Saline Ammonia,
Albuminoid Ammonia,
Not
Estimated.
Do.
Not
Estimated.
Do.
Not
Estimated.
Do.
0-003
0-008
0-002
0-005
Free.
0-014
Free.
0-005
Oxygen absoi'bed in 15
minutes, at 27° C,
Do.
Do.
Do.
Not
Estimated.
Not
Estimated.
0 005
0-005
Oxygen absorbed in 4 hours,
at J /
Do.
Do.
Do
0-104
0-040
0-076
0 035
Chlorine, - - - -
75-6
2-1
13-3
10
1-2
6-5
6-5
Suspended Solds —
Volatile or Organic,
3-64
4-51
4-00
None.
1 -45 1
Small
Small
Mineral, - _ -
5-88
3-99
2-44
Do.
1-05 J
Quantity.
Quantity.
Total,
9-52
8-50
6-44
Do.
2-45
Solids in Solution —
Volatile or Organic. - f
Mineral, - - - {
Not
Estimated.
Not
Estimated.
Not
Estimated.
1 5-18
J 5-39
4-34
4-62
15-9
41-7
14-0
39-9
Total, -
10-57
8-96
57-6
53-9
Poisonous Metals,
None.
None.
None.
None.
None.
None.
None.
From these data Mr. Harris arrived at the following conclusions: —
"Sample No. 1. — This sample was labelled — Drinking Water from ship ' Umile
Siegfried ' ( French ). Tank filled at Porro, N.C. The quantity of the
sample submitted was totally inequate for a complete analysis. However,
the fact that the sample contained 75-6 grains of chlorine per gallon (which
is equivalent to 124-7 grains of sodium chloride) is sufficient to indicate that
this water, as represented by the sample, is unfit for potable purposes.
" Sample No. 2. — This sample was labelled — Sample of Water from, s.s. ' Crown of
Navarre.' Filled at Cape Breton, I^.S., 20 days ago (October 17th, 1905).
Owing to the quantity of the sample supplied being relatively small, the scope
of the analysis was restricted, and, except that the chlorine figure was within
the limit usually found in drinking water, no further comment can be made.
Hood suggested for use
w/TH Chip Potato boiling Ranges.
21
FACTOEIES AND WOEKSHOPS.
There are now on our Eegisters 4,697 workshops in full operation, or 404
in excess of the number at 31st December, 1904. The number of workshops
measured and registered during 1905, along with other information regarding
them, will be found in Appendix VI., and in the immediately succeeding
Appendix are given the details respecting all the registered workshops now in
the City.
From the latter it will be seen that the total number of employees in these
premises under the constant supervision of the Department is 33,215. 12,905
are men, 14,950 are women, 5,350 are young persons between 14 and 18 years
of age, while only 10 are under the age of 14.
The work accomplished in the workshops and in the homes of outworkers,
with respect to the suppression of nuisances, structural and otherwise, will be
found under Heading XI. of Appendix II., and need not be reviewed in detail
here. Suffice it to record that the total number of inspections in such premises
was 31,654.
I received 19 complaint notices under Section 5 of the Factory and Work-
shop Act, 1901, from His Majesty's Inspector of Factories — 9 in the Central
District, 3 in the Eastern, 1 in the Southern, 4 in the Western, and 2 in the
North-Western. All received careful attention.
Under " Notice No. 35," I received from the same Inspector 266 notices
with regard to the measuring and registration of workshops, and under Section
9 of the same Act he forwarded me 140 notices with respect to the requirements
of the Sanitary Accommodation Order, 1903. In 91 cases out of the 140 the
needful work was completed in terms of the above Order.
Details as to these will be found in Appendix VIII. attached to this Eeport.
EESTAUEANTS.
In addition to the above, 92 restaurants were measured and registered
during 1905. We have now 271 restaurants on the Eegister and under super-
vision, employing 218 men, 742 women, and 71 young persons under IS years
of age.
A considerable number of complaints continue to be made with ref erence to
the ofiensive odours which come from the kitchens of the restaurants known as
Fried Fish Shops." Investigation has shown that, for the most part, the
odours complained of are due to the occupiers (mostly foreigners) frying their
fish in such a manner that the oily vapours have free access to the atmosphere
of the kitchen and shop, wherefrom they escape to the adjacent staircase or to
the dwellings above through crevices or small openings in the ceiling or behind
the wall linings. In order to prevent this form of nuisance, I have caused a
sliding hood to be designed over the pan in which the boiling oil or fat is
contained. (See sketch on opposite page.)
The new Bj^e-laws now being prepared under the Glasgow Building
Eegulations Act, 1900, contain a clause dealing with this matter, which will
render compulsory the fitting of some such apparatus over the boiling or frying
stoves in restaurants of this kind.
22
SALE OF FOOD AND DRUGS ACTS.
During 1905, 885 samples of food and drugs were procured by tlie four
Inspectors set aaprt for this duty. 682 of tkese were taken under the Acts, and
submitted to Mr. W. F. Harris, tbe City Analyst. The following tabular
Statement exhibits the results of their operations in detail : —
1 ^
er of Sample
'rocured.
rH
"3 rrt
Article.
er Certifie
enuine.
er Certifie
Iterated.
ber in whi
oceedings
1 institute(
Amount
Recovered
in
Fines
and
m
'-^
'>
O
g
1
Numb
Adu
c " r
Expenses.
3
£ s. d.
Sweet Milk,
178
115
63
48
101 5 4
2
Skimmed Milk,
16
12
4
4
8 0 0
—
Cream, ...
4
2
2
—
—
—
Butter,...
149
140
9
7
22 14 0
—
Margarine,
18
18
— •
18
32 8 6
1
Cheese,
12
12
—
—
—
—
Lai'd, ...
22
22
—
—
—
Coffee, ...
42
42
—
—
—
—
, Coffee and Chicory, ...
4
4
—
—
—
Pepper,
22
22
—
—
Mustard,
7
7
—
—
Cream of Tartar,
27
26
1
—
—
Tartaric Acid, ...
1 D
1 o
3
1
i
1 1 0
— ■
Ground Ginger,
22
22
—
—
Crushed Linseed,
1.3
13
—
—
Ofl.'t.TYl P?i 1
LJ-LLl^CLJ., ... ... ...
9
9
Tapioca,
10
10
—
Arrowroot,
2
2
—
Bailey,
5
5
Preserves,
4
3
1
1
1
Camphorated Oil,
15
14
1
1
1 12 0
Ohve Oil,
9
9
Cascara Sagrada,
17
17
Milk of Sulphur,
9
9
Lime Water, ...
9
8
1
1
1 12 0
Extract of Malt,
1
1
Brandy,
20
13
7
4
12 12 0
Whisky,
12
*12
Rum, ...
8
*7
1
Obstructing Officer, ...
1
3 3 0
Totals,
682
589
93
86
184 7 10
4
* Certified genuine in respect to alcoholic atrength only.
Samples procured under above Acts, ... ... ... ... 682
„ for Private Test purposes, ... ... ... 203
Total Samples procured, ... ... ... ... 885
Twenty-two samples of so-called Ciders were procured and submitted for
analysis on behalf of the National Fruit and Cider Institute, Long Ashton,
Bristol. In 10 of these salicylic acid was found, and in 1 the estimated quantity
was equal to 45'62 grains per gallon. The full details of analysis have not yet
been furnished.
It is to be regretted that the Adulterated Butter Bill — in a somewhat
amended form — has not yet found a place on the Statute Book, which would
make provision for dealing with the makers and vendors of the water-logged
and impoverished commodities presently being sold with impunity as butters.
In October, I caused, under the instructions of the Committee, a prosecu-
tion to be taken against a firm of grocers for selling " Apple Black Currant
Jam," which was certified by the Public Analyst to contain 17"4 per cent, of
23
starcli glucose, wliicli is extraneous to sugar and fruit. The starcli glucose
syrup used by certain manufacturers is made, for the most part, in the United
States, and is prepared by treating maize in a dilute solution of sulpliuric acid.
It bas only one-tliird of tbe sweetening power of true sugar, ^and costs, on tbe
average, lis. 6d. per cwt., as against 19s. Gd. per cwt., tbe price of sugar.
After trial, tbe Sberifi-Substitute dismissed tbe case, stating tbat be was
not able to bold, on tbe evidence before bim, tbat sucb a percentage as IT "4 of
glucose was inadmissible. I look upon tbis decision as important, as I am con-
vinced several manufacturers use starcb glucose as an adulterant. I tberefore
make no apology for giving tbe Sberiff's decision and note in full.
In giving judgment, bis Lordsbip said —
" This is a complaint by the Inspector for the City and Burgh of Glasgow against
grocers for selling a pot of jam which Avas stated not to be of the nature, substance,
and quality of the article demanded, which was apple black currant jam, and it is
stated not to be of that substance and quality in respect that it contained 17'4 per
cent, of glucose. I do not think it is necessary for me to go into detail as to the
chemical constitution of glucose, but I may say it is admitted that it is a harmless
ingredient and a nutritious article of diet; and, speaking roughly, it is formed, to the
extent of from 50 to 70 per cent., of dextrose and maltose, which are sugar, and to
the remaining extent of dextrine and water — dextrine not being a sugar, but, as I
ru:iderstand it, a gummy, starchy substance, which is without sweetening qualities.
" Now, in order to establish this complaint, it is, of course, necessary for the corn-
plainer to satisfy me that glucose is extraneous to jam, and his averment which he
undertook to prove was that jam, when genuine, consisted altogether of fruit and sugars
derived from cane or beet. To establish this (what I may call a standard of jam),
the complainer produced two classes of witnesses — the evidence of skilled witnesses,
such as Mr. Harris and Dr. Clark, and the evidence of manufacturers in the jam trade.
As regards the first class of evidence (that of the chemists), it would, of course, have
been of very great value if it had been directed upon the point of what actually con-
stitutes jam, when one regards jam as the article sold in the market.
" After careful consideration of the evidence of these gentlemen, however, I am
unable to see that it is directed to that point at all. It seems to me that these gentle-
men,-in giving their evidence, had been giving it very much as to what jam ought
to be - — not, as matter of fact, what it is. Now, it seems to me that the question I
have to consider in dealing with this complaint of contravening the Sale of Food and
Drugs Act is — What is jam, as sold in the market and commonly manufactured for
that purpose? I think one must have regard to the facts as they are, and, as there is
no legal standard, one must arrive at an idea of what jam is by finding what has, as
a matter of fact, been sold for a considerable period under that name. In other words,
the question is, Avhat a purchaser has a reasonable right to expect to get when he asks
for jam in a shop.
" The question cannot be answered by considering the opinion of eminent analytical
chemists as to what they think jam ought to consist of, but by regard to the practice
of those who manufacture and sell jam. Now, as to the evidence of manufacturers,
there were three manufacturers examined for the prosecution, and the result of their
evidence may be said to be that they admit that the use of glucose is extremely common
in the manufacure of jam, and, further, they could not say there was any standard of
jam, or that the addition of a percentage of glucose rendered the article not jam.
Now, it seems to me that, even on that evidence, apart from the evidence for the
defence, it is impossible to find that the complainers have established what is essential
to the success of the complaint — that jam, when genuine, consists of fruit and sugars
derived from cane or beet. The evidence of the manufacturers for the defence was to
the effect that the use of glucose was so common in the making of jam as to be almost
luiiversal, and that it has been in use for a number of years past, one of the Avitnesses
putting it down at twenty-five or thirty years, and that, as to the amount, the recipes
of various manufacturers varied. In some cases, as appears from the evidence, glucose
is not used at all, the fruits not requiring it, but in other cases glucose is said to be
very useful, not only because it is cheaper, but because it Avas admitted that it made
it easier to manufacture the jam, while at the same time the jam would not granulate
or crystallise so readily. If these are the facts — that for a great numljer of years,
amounting to tAventy-five or thirty, jam made Avith glucose along AA-ith sugars from
24
cane or beet has been commonly sold in the market — I think it is quite impossible for
me to hold that there is a standard for genuine jam which excludes glucose as extraneous
matter, and therefore I have come to the conclusion that the oomplainer has failed to
establish this essential averment in the complaint — that genuine jam consists altogether
of fruit with cane or beet sugar.
" It may be remarked, in passing, that such a standard would exclude other sugars,
such as sorghum or maple, but, as far as the market here is concerned, I do not think
these sugars enter into the constitution of jam.
'■' For these reasons, I come to the conclusion that the jorosecution fails. In these
circumstances, it is not necessary for me to deal with another point raised — whether
the small label on the top of the pot, intimating that the contents consisted of fruit
and sugar mixed with other harmless ingredients, would protect the respondents. I
do not need to go into that, because the whole complaint fails.
" I may say, however, that towards the end of the case the complainer adopted a
rather different ground, and attempted to show that the percentage of glucose in this
particular pot of jam was excessive. I do not think, of course, the complainer could
succeed under this complaint on any such ground, because he had undertaken to prove
that genuine jam consisted of fruit and sugars derived from cane or beet, to the
exclusion of glucose, and he has not given notice to the respondents that he would
raise the question as to what was a permissible percentage of glucose. In these circum-
stances it would be very unfair for me to deal with the case on that footing. Apart
from that, as I have said, the recipes of various manufacturers differ, and I am not
able to hold, on the evidence before me, that such a percentage as 17"4 of glucose would
be inadmissible. It is to be remembered, as I pointed out, that glucose is a harmless
substance, and that more than 50 per cent, is sugar. I therefore assoilzie the
respondents, and under the Sale of Food and Drugs Act cannot give expenses."
Mr. M'lntyre, for the complainer, intimated tlaat the prosecution might
ask his Lordship to state a case for appeal to the High Court.
On careful consideration, it was considered inexpedient to proceed vs^ith an
appeal, but, pending further legislation, the public Avould be well advised if
they took care to ascertain, when they purchase jams or jellies, that it is the
genuine article, and guaranteed " free from starch glucose or other preserva-
tives than pure cane or beetroot sugar." It should be remembered that starch
glucose contains about 30 per cent, of a substance known as dextrine or British
gum, which is quite foreign to fruit of all kinds, and is unknown in real sugar.
It came to my knowledge in July that children's coloured toys were being
sold in a certain warehouse which were of a suspicious character. Seven toys
were purchased, and submitted to the City Analyst, Mr. Harris. He found
that two of the samples contained lead, and, on my communicating with the
vendor, he at once stopped their sale, and promised to send them back to the
manufacturer. The articles in question consisted of coloured birds, dogs, men,
women, and clay models of policemen. Most of them had whistles attached,
which made them attractive to children.
FISH A'^B GAME INSPECTIOI^T.
The following are the details of the work done in the Corporation Fish
Market by the special Inspector attached to this department : —
596 separate parcels were found unfit for food, and were destroyed by the
various consignees, at the instance of the Inspector : —
Fresh Fish Destroyed.
Lbs.
Herring,... ... ... ... ... ... ... 13,956
Haddock, ■ 4,288
Whiting, 3,254
Cod, 4,210
Codling, 4,400
Ling, 340
Mackerel, 470
Carry forward,
30,918
25
Brought forward,
Bream, . . .
Berglot, . . .
Sparling, . . .
Grilse,
Shark,
Halibut, ...
Whitches,
Black Soles,
Lemon Soles,
Roes,
Various, ...
Cray,
Crabs,
Shrimps, ...
Eschallops,
Cockles, ...
Mussels, ...
Total,
Lbs.
30,918
620
400
10
30
500
156
320
36
14
28
160
200
130
112
210
726
448
35,018
Cured Fish Destroyed.
Herring,
Haddock,
Whiting,
Saithe,
Fillets, ..
Prawn,
Lbs.
270
1,596
546
560
854
28
Total,
3,854
Game, Poultry, and Rabbits Destroyed.
Head.
Black Cock, ... ... ... ... .. ... 66
Hazel Hen, 260
Partridge, ... ... ... ... ... ... 2
Pigeon (Wood), ... ... ... ... ... ... 23
Turkey, ... ... ... ... ... ... ... 55
Fowl, 82
Duck, ... ... ... ... ... ... ... 6
Rabbit, 507
Total, 1,001
This sliows a decrease of 11,118 lbs. of fresli fish and 9,742 lbs. of cured
fish destroyed, as compared with last year, and an increase of 493 head of game,
poultry, and rabbits. In all, 897,518 parcels were inspected, a decrease of
73,120 as compared with 1904.
1,988 visits were also paid to the fish restaurants and 565 to the retail fish
shops throughout the City, and 1,159 inspections were made of fish hawkers'
carts and barrows. 31 fish restaurants, 1 retail fish shop, and 1 poulterer's
shop were found to be in a filthy condition, and the owners notified. In each
case the necessary cleansing was duly carried out.
Eight cases of illegal trafficking in poached salmon were reported to the
Fishmongers' Company of London, resulting in seven convictions being
obtained. One case was found not proven.
Many complaints were received with regard to fish of the salmon kind,
coming from the Clyde and Leven Rivers (Dumbartonshire), being tainted with
pollution, and unfit for food.
A small office has been erected in the Fish Market gallery for the use of
the Fish Inspector.
26
DAIRY OEDERS AJ^D CATTLE-SHEDS ACT.
At December 31st there were 1,254 milk purveyors and 499 ice-cream
dealers in Glasgow, as compared with. 1,229 and 449 respectively in 1904. Iso
breach of the Regulations was of such a character as to necessitate a prosecution
in Court.
There was a reduction of two City byres during the year, there being now
81, in which 842 cows are stalled. As time goes on, the number of City-stalled
cows steadily diminishes. In 1902 there were 967; in 1903, 939; and in
1904, 865.
Model Regulations anent Dairies, Cow-sheds, and Milk-shops were issued
by the Local Grovernment Board during 1905, which contain several new pro-
visions. It is my intention, when time permits, in conjunction with the Medical
Officer and the Veterinary Surgeon, to present to the Health Committee several
recommendations with a view to the amendment of our present Regulations, so
as to bring them into line with the Local Government Board's proposals. Some
steps should also be taken soon to give practical effect to the powers contained
in Sections 24 and 25 of the Glasgow Police (Amendment) Act, by which milk
suspected to be conveying disease to the public may be stopped at the source
of supply, wherever situated, and the affected cow or cows so dealt with as to
prevent their milk being sold within the City.
In the recently annexed burgh of Kinning Park there are 15 milk pur-
veyors and 2 ice-cream vendors. In the premises of five of them it was needful
to have structural alterations carried out. In one byre for 12 cows extensive
alterations were made so as to improve the drainage, ventilation, and lighting,
and a milk scullery was added to secure the proper washing of the milk utensils.
SHOP HOURS ACTS, 1892-1895.
4,396 primary inspections were made in shops by the special officer under
the above Acts. In one case a firm of bakers was found employing young
persons in six of their shops in contravention of Sections 3 and 4 of the Act.
They pled guilty when brought before the Sheriff, and were fined 10s. for each
offence, with 17s. 6d. in addition for Court expenses. Three other shopkeepers
were found contravening the Acts. Two of them were prosecuted — one being
fined in 20s., with 19s. 6d. for expenses, and the other got off on the girl deny-
ing in Court what she had previously told the Inspector with regard to her
working hours.
522 Shop Hours !N"otice Cards were issued from the office to shopkeepers,
39 of these being charged threepence for them, in respect that cards had been
previously supplied, and lost through carelessness.
The following short statement shows the details of the work done under
these Acts : —
First Inspections, ... ... ... ... ... ... 4,396
Oifenders found contravening Section 3, ... ... 1
4 5
,, ,,1:, ... ... t>
Prosecutions (against one firm), ... ... ... ... 6
Secondary Inspections,... ... ... ... ... ... 8,005
Offenders found contravening Section 3, ... ... 2
4 1
)) )) J) ^) ... ... X
Prosecutions, ... ... ... ... ... ... 2
Heinspeciions to former Offenders, ... ... ... ... 85
Found complying; ... ... ... ... ... All
Shop Hours Cards given out, ... ... ... ... ... 522
,, „ paid for (3d. each), ... ... ... 39
Fines imposed and recovered (,£4, with £1 I7s. costs), ... £5 17s.
DRAWING SHOWING CATCH-PIT AND BAFFLE WALLS IN BOILER
FLUE, WITH WATER-SPRAY IN CHIMNEY, FOR THE RETENTION
OF SMALL PARTICLES OF ASH AND SMUTS FROM FORCED
DRAUGHT FURNACES.
5cA LE. i"- I Toot
Sanitary Chambers, |
Glasgow, March, 1906. I
I
I
i
I
I
i
I
I
I
1
I
i
1
i
I
I
i
I
j
S
■i
j
t
I
I
1
\
I
27
SEATS FOR SHOP ASSISTANTS ACT, 1899.
The following was the work done under tlie above Act: —
First Inspections,
Found complying,
,, without Seats,
Provided Seats, ...
Prosecuted,
No prosecutions were necessary, as shopkeepers, on being warned, at once
provided the seats required ; but the Inspector reports that in several instances
the mere proAasion of seats does not give any real easement to the girls, as they
are not permitted to use them, except at the risk of dismissal, such masters
alleging that they " have no use for girls who have time to sit."
1,957
17
17
0
SMOKE ABATEMENT.
Steady progress continues to be made in the work of reducing the daily issue
of smoke from factory chimneys. 14,406 observations of svich chimneys were
made during the year by the four Smoke Inspectors, who also made 1,395
careful inspections of boiler and other furnaces Avhich were recognised as
regular smoke producers. As will be seen, on referring to Part XII. of
Appendix II., 127 prosecutions were taken against offenders, resulting in 124
convictions, and fines were imposed amounting to £111 lis. 6d.
In 98 of these cases the excessive smoke production was due to carelessness
or want of skill on the part of the firemen, while in the remaining 2G cases,
although the element of careless firing played a certain part, want of chimney
draught, insufficient boiler power, defective flues, or other structural causes
were mainly responsible for the nuisance produced. 15 cases which were
departed from were so dealt with after hearing representations on the part of
the various offenders to the effect that the excessive smoke made was caused by
some accident to the furnace or boilers, or to the unavoidable absence of the
regular fireman.
As indicated above, improvements on furnaces continue to be made at our
instance, details of which will be found in the Appendix referred to.
A special complaint came to me, through a. member of the Committee, of
two chimney stalks in the City from which an abnormal discharge was con-
tinually being made of small particles of ashes, which descended like black
hail all round the immediate neighbourhood of the chimineys. As this peculiar
discharge was not of the nature of smoke, I had to take special means to combat
it. Eive dust gauges were set down on the roofs of adjacent buildings all round
the chimneys in question, where they were left for fourteen days. The contents
were then placed in the hands of the Corporation Chemist, who reported on the
28th of August that on each square foot of surface there had fallen from 5 to
94 grains of the grit and dust complained of. On a second test being made,
during fifteen days in October, the amount which had fallen into the five boxes
was found to have increased in two of them to 182 and 254 grains per
square foot.
As this discharge was being caused by the firm in question burning a low-
class fuel under forced draught in closed ashpits, representations were made to
the firm, who at once set about making certain 
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